The combined reductions would total more than 4 percent of New York hospitals’ total incomes — well over $1 billion a year — a prospect that left industry officials and elected officials struggling to describe the dire effects.

“This is the worst, the most damaging scenario,” said Kenneth E. Raske, president of the Greater New York Hospital Association.

In particular, the cuts would take money from the academic medical centers that teach new doctors and do a large share of advanced medical research. New York City has by far the largest concentration of teaching hospitals in the country, training about one in seven of the nation’s interns and residents, many of whom go on to practice elsewhere.

A hospital-by-hospital analysis by Mr. Raske’s group shows how uneven Mr. Spitzer’s proposed cuts would be, with the losses concentrated in the city. In all, the governor would cut about 1 percent from hospitals’ revenue.

While some hospitals would actually gain money from the changes, others would see significant cuts, like two hospitals in Brooklyn that are already short of cash — Interfaith Medical Center, which would lose 6 percent of its total income, and Brooklyn Hospital Center, which would lose 4 percent.

On seeing the plans laid out by Mr. Bush, Senators Charles E. Schumer and Hillary Rodham Clinton, members of the new Democratic majority in Congress, vowed to fight them.

“Much of the damage that the president seeks to do will be undone, but to say we can eliminate all of it would not be right,” Mr. Schumer said.

He called the president’s proposals “an all-out assault on graduate medical education” and a “dagger to the heart of New York health care.”

In its budget summaries, the Bush administration described the changes as needed to rein in rapidly growing health care spending, and to fight the practice of expanding government programs beyond their intended boundaries.

Medicare, the federal health plan for the elderly and the disabled, is a major supporter of training programs for interns and residents at teaching hospitals. In New York and some other states, Medicaid, the program for the poor, also pitches in for that training — known as Graduate Medical Education, or G.M.E. — while other states have opted not to take that step.

Mr. Bush proposed gradually eliminating that use of Medicaid money — about $600 million a year in federal funds for New York, more than any other state.

“Current law does not explicitly authorize such payments,” the administration’s budget summary said. “Paying for G.M.E. is outside of Medicaid’s primary purpose, which is to provide medical care to low-income individuals.”

The president also called yesterday for abolition of one type of Medicare payment for doctor training — again, a cut that would disproportionately affect New York. The hospital group estimated the cost to New York hospitals at more than $100 million a year.

Two weeks ago, Mr. Bush proposed a different sort of cut in Medicaid that would affect only certain public hospitals, particularly New York City’s Health and Hospitals Corporation. The corporation and New York State estimated the cut to the city hospitals at $350 million a year.

Mr. Spitzer has proposed cutting $1.2 billion a year in health care costs, including more than $350 million in hospital payments.

But the loss to individual hospitals would vary widely, depending on their reliance on Medicaid, how many doctors they train, and how much those training programs have changed in size over the last 25 years.

Under the Spitzer plan, St. Barnabas Hospital in the Bronx would gain more than $7 million a year, while Beth Israel Medical Center in Manhattan would lose almost $15 million, the most for any single hospital, according to the Greater New York Hospital Association. New York-Presbyterian hospital, actually two very large hospitals that merged, would lose almost $24 million a year.

Just 15 hospitals would absorb more than half the losses for all of the state’s more than 200 hospitals, and 14 of the 15 are in New York City. Most of the big losses would be suffered by hospitals that are relatively successful financially and in relatively affluent neighborhoods, but there are notable exceptions, like Interfaith and Brooklyn.

Mr. Spitzer has described his changes as reforms designed to make the health care system more sensible and responsive to patient needs. The industry and its main union, 1199 United Healthcare Workers East, say that in pursuit of abstract theories, the governor would make cuts that are so abrupt and deep that they would make health care worse, not better.

Jennifer Cunningham, a consultant to 1199, said, “The Bush and Spitzer cuts to teaching hospitals would be a double-whammy — more than double.”