“Why do you rob banks? Because that's where the money is. Why do you go to the community? Because that's where the patients are," said Michael V. Sack, chief executive of Hallmark Health System Inc., which operates Lawrence Memorial Hospital in Medford and Melrose-Wakefield Hospital in Melrose.

“It puts community hospitals in a very vulnerable position," he said.

The competition from academic medical centers adds to pressure already being applied by community doctors and large physician groups that are offering their own medical services for profitable procedures such as radiology, radiation oncology, outpatient surgeries, endoscopies, and cardiac diagnostics.

And while community hospitals are performing fewer lucrative procedures, they are left to cope with the same overhead costs and an obligation to treat anyone who walks through the door, regardless of their ability to pay, hospital executives said.

News of the Tufts-New England Medical Center and New England Baptist Hospital plans was published in the Globe on the same morning community hospital executives gathered for a regular meeting of the Massachusetts Council of Community Hospitals. The meeting buzzed with worries about added competition, participants said.

Several executives who attended said later that they are increasingly concerned about fundamental trends in the state's healthcare industry.

Massachusetts already has the costliest healthcare in the nation, according to national data. Bringing expensive teaching medicine to the suburbs will exacerbate the problem, community hospital executives said.

“That potentially edges out high-value, efficient care in favor of yet more terrific but really expensive care that carries the burden of the costs of teaching," said Delia O'Connor, chief executive of Anna Jaques Hospital in Newburyport. “I'm not sure we can afford this as a state."

In fact, many community hospital leaders say their facilities are able to provide some medical services at lower costs than Boston-based hospitals, and at a higher level of quality.

Still, despite double-digit increases in annual insurance premium costs, employers and political leaders have yet to demand major changes in how healthcare is delivered. Because Massachusetts has so many top-level teaching institutions, residents have become accustomed to seeking even routine care at expensive hospitals simply because they can.

About half of all hospital admissions in Massachusetts are at academic medical centers - about 2 1/2 times higher than the national average, according to national and state statistics. The disparity shows no sign of easing. Massachusetts General is building an outpatient center in Danvers, and already operates one in Waltham within sight of traffic streaming by on Route 128. Beth Israel is planning to expand services at its Beth Israel Deaconess Hospital-Needham Campus. And Children's Hospital Boston is moving more services to Waltham and other satellite locations.

This is not all bad news for local hospitals. Each of the downtown hospitals also is seeking stronger affiliations with community hospitals, which community hospital executives said may mitigate the impact of their presence. Affiliations produce referrals to downtown medical centers while allowing community hospitals to enhance their reputations with recognizable brands.

“If you can't beat 'em, join 'em," said Christine C. Schuster, chief executive of Emerson Hospital in Concord, which has clinical partnerships with Mass. General, Tufts-New England Medical Center, and Lahey Clinic.

“We really have to balance the collaboration and the competition."

Ellen Zane, chief executive of Tufts-New England Medical Center, has sought to reassure community leaders that she does not want to compete with community hospitals to provide basic care. She said her goal is to offer the most advanced procedures into the suburbs, eliminating the need for many patients to travel into the city.

Zane and New England Baptist chief executive Joseph Dionisio sent a letter to regional hospital chiefs this month in which they outlined their rationale.

“Studies show that more than 160,000 patients in Eastern Massachusetts drive into Boston to receive care at an academic medical center," they wrote. “We believe some of these individuals would benefit if they could access care for critical and complex medical conditions in a more convenient location."

The theme of the letter was cooperation. “We seek to complement the excellent services community hospitals like yours provide by offering advanced medical services closer to and more convenient for patients," it said.

John Erwin, executive director of the Conference of Boston Teaching Hospitals, said academic medical centers are responding to demand from Massachusetts residents for more convenient care.

“It's going to where the people are and bringing the best of academic medicine out to the community," Erwin said. “The teaching hospitals are just responding to the market."

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