In the heart of this city's downtown, workers pour concrete into a massive 14-foot pit.
The concrete will create thick walls for a proton beam cancer therapy center, the latest Mayo Clinic construction project that has downtown Rochester in the midst of a construction boom.
Cranes mark the skyline as the clinic builds the facility and expands Saint Marys Hospital, projects that will help the medical center capture the growing share of older patients.
U.S. Census data show the number of Minnesotans age 65 and older will increase by 40 percent in the next 10 years, shifting demographics that already are evident. Last year, such patients accounted for nearly half of the 1.1 million patients visiting to the Mayo Clinic and Mayo Clinic Health System.
As more patients visit Mayo Clinic each year, their presence creates a huge ripple effect in Rochester's economy, boosting business for a variety of businesses — from hotels and restaurants to taxi services and car rentals.
But the immediate effect could well be on the construction trades.
About 65 workers are working on the cancer center, a number that will grow to as many as 250 workers as construction peaks later this year, said Joe Toronto, construction project superintendent for Gilbane and Knuston Construction.
"By May of next year, this has to be finished space," Toronto said, [with] "fire suppression, security, lights, 100 percent done for Hitachi to show up with their equipment from Japan."
By equipment, he means pencil beam scanning. By 2015, the center will allow Mayo Clinic to offer cancer patients a more precise form of proton therapy that allows for greater control over radiation doses. The treatment times are shorter and there are fewer side effects than conventional radiation therapy.
Clinic officials studied the technology for seven years before bringing the proton center to Rochester and funding for the $188 million project will come from Mayo's capital budget and generous benefactor support.
"It's a huge draw," Toronto said of Mayo Clinic. "It brings people to live down here. Our safety director has left Minneapolis and relocated to Rochester to be part of the Rochester scene."
A GROWING FOOTPRINT
He's not the only one. The city's population grew from 85,806 in 2000 to 106,769 in 2010, making it Minnesota's fastest-growing city. It also replaced Duluth as the third-largest city in the state.
Mayo President and CEO John Noseworthy said the clinic's growth in Rochester is due in part to the increasing number of older patients with complex illnesses.
"Does Mayo like to see elderly patients? Of course we do," said Noseworthy, an M.D. and neurologist. "We do some our best work in those who need us most, which are the patients who have multiple illnesses. If you will, that's one of our sweet spots."
Mayo Clinic also is building a proton beam cancer center in Arizona and expanding its hospital in Florida.
Mayo Clinic's footprint in Rochester represents approximately 14.6 million square feet, up from 13.1 million in 2001, according to clinic officials.
Noseworthy said it's been about a decade since Mayo Clinic's last major development project in Minnesota, the 20-story Gonda building.
He said each new Mayo building or parking ramp faces some opposition in the community, often from nearby residents.
When the Gonda building opened, half the floors were shell space ready for future use. Today, only the 16th floor remains shell space, and the clinic plans to fill that by 2014.
"[In] many communities, something happens, a university does this or an industry fails and the community sees that and it's there forever to remind them of the mistakes of the past or a change in the economy," he said. "I don't think we're going to see that ... We could mess this up, but we won't."
HALO EFFECT FOR SMALL BUSINESSES
Through the recession, Mayo's institutional growth has been a boon for small businesses in town.
At the Rochester Direct shuttle service, just across the street from Mayo Clinic, cars, vans and taxis stream continuously through the drop-off zone.
In 1993, Kurt Marquardt started Rochester Direct with two vans and five runs to Minneapolis-St. Paul International Airport. The company now has 15 vans, 19 daily departures, and about 100,000 riders a year — more than double what it was five years ago.
With the Mayo Clinic nearby, everyone expects growth, Marquardt said.
"There's a sense of hospitality and caring that I think kind of spills into the rest of the community," he said. "People come here and they really feel like people are concerned about their well-being and what they're doing and what they do for the 70 percent of the time they're not spending in the clinic."
In Rochester, where about a third of the city's residents work at the clinic, it would be tough to find people who will say a booming Mayo is bad for Rochester, or Minnesota, said retired radio host Harley Flathers, who worked for 20 years as early morning announcer on KROC 106.9 FM.
Flathers, who has lived in Rochester for five decades, remembers when there was just one Mayo building. He said the tremendous change has brought both tension and challenges as over the years some residents protested Mayo's continuous growth. Bu he said the transformation has been amazing.
"The community should look upon this as progress in many ways," he said, noting that Mayo Clinic has been good for the community, and its patients. "It helps old people live longer ... It helps overcome a lot of very serious diseases."