After more than a decade of expansion, the Medical College of Wisconsin is grappling with smaller operating margins, a less profitable patient mix and excess research capacity at the school and its hospital partners. The result: The school will cut its budget by 5% for the fiscal year beginning July 1, and layoffs are possible, college spokesman Richard Katschke confirmed. The Medical College's fiscal 2009 operating budget was $800 million. Medical schools across the country are undergoing similar surgeries, some of which are severe.