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Construction workers are all over the High Street area near downtown Buffalo, which is arguably the center of construction activity in Erie County.

Some crews are completing a new vascular center behind Buffalo General Hospital, which includes an emergency room scheduled to open Friday. Others are helping to build a nearby nursing home. There's even work being done on a grassy walkway that will lead to the area where a new Women & Children's Hospital and medical school complex is expected to be built.

In fact, there's so much going on in this five-block area between the Allentown and Fruit Belt neighborhoods that someone who didn't know any better would think they were in the center of a bustling metropolis.

Between what's recently been built, what is now being constructed and what is already on the drawing board, the total price tag is well over $1 billion.

"The amount of construction going on is even mind-boggling to me," said Matthew K. Enstice, president and executive director of the Buffalo Niagara Medical Campus, "and it's only the beginning."

"We're at a maturing point," said James Kaskie, chief executive of Kaleida Health, one of the big players on the Buffalo Niagara Medical Campus. "We now have critical mass. We got momentum. And we have the pieces coming together very well."

For the medical community, this is, obviously, a big deal.

>Gearing up for growth

At a minimum, the consolidation of medical, research and education facilities downtown is seen as a way to replace aging facilities, share resources in an era of tighter funding and make Buffalo a more attractive destination for medical students, specialists and scientists.

Beyond that, it's hoped all these efforts will expand the breadth and depth of services for certain specialties, such as neurosurgery and heart surgery, and also fill gaps in certain areas of care, such as liver transplantation.

And in the most optimistic view, it's hoped Buffalo's Medical Campus will become more of a destination for out-of-town patients and will attract enough successful start-up biotech companies to become an employment engine.

"What we have in mind, and what the Buffalo Niagara Medical Campus has in mind, is to provide a destination for health care," said University at Buffalo President Satish K. Tripathi.

"It creates jobs," said Donald L. Trump, president and chief executive officer of Roswell Park Cancer Institute.

The plan, however, is not without skeptics, who argue the billion-dollar expansion could be a billion-dollar bust, doing little more than moving medical buildings from one part of the city to another without expanding services or attracting much outside investment.

"It's kind of a question of your expectations," said Joseph Cortright, a Portland, Ore.-based economist who specializes in regional economic analysis.

If the region is developing the Medical Campus to meet the needs of the community and a growing health care industry, that's one thing, he said.

But if the region expects it to be a springboard for lots of biotech jobs that wouldn't otherwise be in Buffalo, then that's something else.

"That's a much harder thing to do," Cortright said. "That part of it, I'm very skeptical of."

>Critics raise questions

Others wonder what will happen to their part of the city when existing institutions -- such as Millard Fillmore Hospital, Women & Children's Hospital or the UB School of Medicine and Biomedical Sciences -- eventually make the move to the Medical Campus.

And then there are those who wonder where all the thousands of additional workers and patients coming into the medical corridor will park their cars every day.

Finding a place to park is already a hassle.

"It's awful," said Sarah Pannullo, who works on the Medical Campus.

Planners are aware of the concern.

"We have two things we need to strengthen on this campus," Enstice said. "One is transportation. Two is energy. We're more than doubling the size of the infrastructure needs of this campus."

But, in the end, there is growing consensus that something has to be done to address Buffalo's fragmented system of medical care.

Because for years, hospitals here have competed for limited patients, funds and staff, preventing any one of them from offering care at levels comparable to the best in the country and making it more difficult to recruit new doctors.

>Progress ramps up

It all started, Medical Campus planners said, a decade or so ago, when then-Mayor Anthony M. Masiello asked a question: "Why don't we have a Medical Campus in Buffalo?"

The region already had a jump on it with more than $241 million in renovations to Roswell Park in 1998.

The planners and medical community started talking, and by the end of 2002 they had a master plan with suggestions on how to get things done.

And in a twist that is a bit out of character for a community that spent a decade discussing an international bridge that was never built, and several years luring a national outdoor recreation store that never came, the Buffalo Niagara Medical Campus began taking shape.

A new Hauptman-Woodward building went up in 2005.

The following year came the University at Buffalo's center for bioinformatics.

So did Roswell Park's genetics and pharmacology building.

A portion of the old Trico building was renovated as research and development space last year and is fully occupied.

Next year, the 10-story vascular center is scheduled to open.

Then, a new parking ramp.

Then, a new nursing home.

And there's more to come.

UB announced it will relocate its medical school from the South Campus to the Medical Campus by 2016.

That move has fast-tracked plans for a new Women & Children's Hospital, probably at Main and High streets.

The medical school and pediatric hospital are what Tripathi calls a "tipping point" for the Buffalo Niagara Medical Campus.

"What's missing there is really the medical education and also the synergy that exists between Women & Children's and the general hospital," Tripathi said. "It's already a great place, and a lot has happened, but this really is a big chunk coming together and filling the holes that there might be."

Upward of $1 billion in public and private funding has already gone into the campus, representing 2 million square feet of new construction. Another half-billion of investment and 1 million square feet are already planned.

When it all started, 7,000 people were working on the campus.

Today, there are 8,500, and within a few years, that number is expected to jump to 12,000.

"I think 10 years down the road," Kaskie said, "it will be a major engine for Western New York."

Perhaps.

>Biotech called 'risky'

Health care is certainly a growing industry, but capitalizing on the biotech business will be trickier, particularly since so many other regions are in the game.

The reality is the biotech industry is still concentrated in just a few areas around the United States, Cortright said.

And there's no indication those patterns are changing, he said, which makes it difficult for places like Buffalo.

"It's a very risky business, and there's a lot of turnover," said Cortright, who studied biotech clusters for the Brookings Institution, a Washington, D.C.-based think tank. "Those two factors lead people and companies and investors to converge on places like Boston, San Francisco and San Diego."

Still, it all makes for a lot of activity in the area bounded by Main Street, North Street, Goodell Street and Michigan Avenue, where scores of men, and a few women, in yellow hard-hats could be seen working on a recent day.

In a community with high unemployment, the projects are putting a lot of people to work.

"Oh, my God, it's got to be easily over 1,000 people," said Paul Brown, president of the Buffalo Building and Construction Trades Council. "Not all at one time, but at least that many. It's been great for the construction jobs."

And all that work is creating cautious optimism and hope.

More jobs. Better health care. Positioning Buffalo to excel in specific fields of medicine.

"We used to talk about this area as a steel industry," Enstice said. "Now, we want to talk about it as an industry built around innovation."

Buffalo News Medical Reporter Henry L. Davis contributed to this article.

email: jrey@buffnews.com and sschulman@buffnews.com