DURHAM - Duke University Health System has proposed the biggest expansion at its flagship hospital in a quarter century to keep pace with a growing and aging population.

The health system is asking the state for permission to spend $596 million on a 548,420-square-foot, seven-story building that will increase its capacity to serve patients.

It also could serve as an economic catalyst for the region. Duke expects 1,000 new jobs when the facility is complete, likely by 2013.

"We want to be here to meet the needs of this community," said Kevin Sowers, chief operating officer of Duke Hospital. "It's an incredible opportunity to create the next facility that will serve the next generation."

The size and scope of the project underscores a health-care building boom that's taking place here and across the country.

With the planned Duke complex, easily $1.5 billion in upgrades or expansions at Triangle medical facilities have been announced, started or completed this decade.

UNC Hospitals, for instance, is expanding its cancer center in Chapel Hill. WakeMed is adding beds at its hospitals in Cary and Raleigh. And Rex Healthcare and Franklin Regional Medical Center on Friday announced plans for a $103.9 million hospital in Youngsville.

"A huge part of it is the population growth," said Dawn Carter, president of Health Planning Source, a Durham company that helps hospitals prepare regulatory applications for new projects. North Carolina's population has grown by a third since 1990.

And hospitals need to stand out.

"There's a battle for market share and market presence," Carter said. "In the industry, there is an increasing awareness that you have to have some size to get economies if you're going to be successful for the long term."

Staying in the game

Academic medical institutions, especially, have little choice but to upgrade and grow. For them, it's not just about treating patients but also attracting top faculty and students.

Doctors and researchers want state-of-the-art technology to develop new treatments that hospitals then use to attract new patients.

In that way, hospitals such as Duke are in a global competition.

The nation's top academic medical centers have billions of dollars in projects under way. Johns Hopkins in Baltimore is spending $1.2 billion on two new towers. The Reagan Medical Center at the University of California at Los Angeles is spending $1.3 billion.

"It's the price of staying in the game," said Jeff Luck, a director with the consulting firm Sg2, which counts Duke among its clients. Hospitals usually renovate older buildings as much as they can, but eventually need new buildings because new equipment simply won't fit, he said.

A research building constructed in 1947 will be razed to make room for Duke's new facility.

With its expansion, Duke plans four 24-bed intensive care units, two 32-bed intermediate care units and 16 additional operating rooms. The hospital is licensed for 924 beds. It aims to consolidate heart care on one floor in the hospital, which will adjoin its current main building, to create a heart center.

Patient rooms will be larger to accommodate family, Sowers said, and the hospital is considering amenities such as healing gardens. Hospital executives first announced plans for the expansion in January. Friday's announcement adds details.

Banking on approval

Because of the way health services are regulated in North Carolina, Duke must get approval -- called a Certificate of Need -- before moving forward with the expansion. It must prove there's a need for the facility and that it won't raise medical costs unnecessarily.

Sowers said that he thinks the hospital has a good case.

Duke is already facing a space crunch. On any given day in the past year, for instance, the intensive care unit has been 91 percent filled, Sowers said. Add in the aging population -- people over 65 use about four times as many health-care services as people who are younger -- and Duke is banking on approval.

The state will consider any objections to the plan. Neither WakeMed nor UNC, two of Duke's chief rivals, plan to oppose the expansion, officials said.

If all goes as planned, Duke could begin construction in fall 2008. It will be the biggest expansion since its main building, Duke North, was built in 1980.

(Staff writer Alan M. Wolf and researcher Paulette Stiles contributed.)