BALTIMORE -- Sinai Hospital is cutting about 200 jobs from its full-time work force of 2,600 because of a dwindling occupancy rate, officials said.

Leonard Marcus, Sinai's vice president for employee relations, said the staff reductions in the coming weeks will include nurses, nursing assistants, secretaries, maintenance workers, physicians and managers.

But Marcus said it is likely many of the reductions can be accomplished by leaving some jobs vacant and through attrition.

He declined to estimate how many people will be laid off, saying that officials still are trying to determine the best way to meet the overall staff reduction -- about 8 percent of the total full-time work force.

"I'd rather not speculate on it," he said. "No matter what goes on, it's going to alarm people unnecessarily. This is being done slowly and carefully because we want to preserve high quality of patient care."

Richard Wade, a spokesman for the Maryland Hospital Association, said Sinai's cutbacks may be among the most severe reactions to economic pressures facing hospitals, but may not be the last.

"There's going to be a lot of pressure on hospitals across the state to do a better job of containing costs," he said.

The staff reductions, the first at Sinai since 1985, are being made because of a decline in the hospital's occupancy rate of about 10 percent in the last year. This year, about 70 percent of its 482 beds are filled, compared with roughly 80 percent a year ago.