Harvard says it has an interest in righting the ship at BIDMC and CareGroup while at the same time protecting the educational mission at the hospitals.

“I would hope that the leadership they bring in will be able to turn them around while keeping medical education strong,” said Daniel H. Lowenstein, HMS dean for medical education.

According to Lowenstein, the medical economy is putting stress on the educational mission of Harvard’s teaching hospitals.

“There’s no question that the past ten years of evolution of the economics of medicine has forced academic medicine to act more and more like a competitive business,” he said.

In the face of deficits and strong competition, hospitals have to look to cut costs. Lowenstein said that since hospitals try to break even on clinical programs, and actually profit from research programs in the form of grants, they have to cut corners when it comes to education.

Lowenstein said that while HMS tuition is $28,000 a year, it is estimated that it costs $120,000 a year to educate an HMS student.

And Harvard’s unique relationship with its affiliates means a different set of challenges. The affiliation is based mainly on a “gentleman’s agreement” whose only text dates from the 1940s.