This summer, the state is working to prepare for the impact of sweeping federal health care reforms. Those changes have the potential to hit Virginia's teaching hospitals especially hard and from nearly every direction.

Hospital administrators and state lawmakers are worried the combination of budget cuts and new responsibilities could lead to catastrophic challenges. Dr. Sheldon Retchin runs Virginia Commonwealth University Health Systems, Virginia's largest teaching hospital. He is painting a sobering, and perhaps downright scary, picture of what could be on the way for Virginia medical centers.

Retchin says federal health care reform brings immense challenges.

"We have a tsunami ahead of us," he said. "Coverage will be a good thing; it's access I'm worried about."

Tuesday, Retchin briefed members of the Senate Finance Committee who are traveling the state this summer and early fall talking about the federal health care plan.

"We have to understand how this is going to impact the commonwealth," explained 17th District Senator Edd Houck (D). "And this is our way of doing it."

One potentially huge impact will be at teaching hospitals like VCU and the University of Virginia Medical Center. Federal cash to support low-income patients is set to plummet at the same time state education dollars are dwindling.

"It's important that the teaching hospitals not be doubly hit hard with this," said Houck.

All of this also comes as Virginia tries to reverse a massive shortage of doctors; an effort that requires years of expensive training at teaching hospitals. And even though most reforms do not take effect until 2014, lawmakers want to start planning now.

"A budget cycle builds on itself," said Houck. "So what we do now is extremely important as we go forward."

Members of the Senate Finance Committee will hold a hearing in Charlottesville on September 21 at UVA Medical Center. That meeting will focus on the specific challenges the hospital will face moving forward.