In this undated photo, The Mayo Clinic, Minnesota's largest private employer, pressed state lawmakers Wednesday, Jan. 30, 2013 to commit more than $500 million toward an ambitious development project tied to the renowned medical center in Rochester, Minn. AP Photo/Rochester Post-Bulletin, Elizabeth Nida Obert

Mayo Clinic's own market research shows there is something missing, a 'satisfaction gap,' before Rochester can become a global medical destination.

The Mayo Clinic, Rochester's flagship employer, announced this week it will invest billions of dollars over the next two decades to attract more patients, as well as add tens of thousands of new jobs to southeastern Minnesota.

Although the city is in the middle of transition and new developments are going up, Rochester lacks diverse job opportunities and recreational options that some say are needed to attract even more residents and visitors.

Claudia Rosenthal is a native of Honduras. She's in Rochester this week to visit her father-in-law, who is here for chemotherapy.

"This is not a tourist, or recreational area. You come and you have your purpose for being here," Rosenthal said.

Rosenthal has been a Mayo patient for a decade. Her husband, Yani, said the skyway, underground walkways, and big signs make it easy to be a patient at Mayo. But once you step off the clinic's campus, the city lacks dining and entertainment options, he says — especially for patients like his parents, who have been here for four months without a car.

Claudia and Yani Rosenthal are staying in Rochester as Yani's father receives chemotherapy at the Mayo Clinic. MPR photo/Liz Baier

"They're repeating the same restaurants a lot, so maybe that's something they need to do: have more restaurants," Yani Rosenthal said. "For senior citizens, so they can go to through the tunnels. That would be great."

Competitors such as Johns Hopkins, Stanford Hospital and the Cleveland Clinic are all located in major metropolitan areas. According to Mayo surveys, when patients come to Rochester for treatment, more than 70 percent of their time is spent outside the doctor's office. And that's when location matters.

Much of downtown Rochester shuts down after 5 p.m. when thousands of employees go home. But downtown is where patients tend to stay during their visits.

Mayor Ardell Brede says Rochester will never have Cleveland's Rock and Roll Hall of Fame. Or offer the history of downtown Boston. But there are improvements the city can make to accommodate its patients, including those with deep pockets.

"There are candidates that just would rather be in a bigger city and Rochester is just not going to be a fit for them."

"We have corporate executives that come in on their Learjet. They're looking for a five-star hotel. We have some very good hotels but they're not five-star," Brede said. "Those are all the things as amenities and things that we can do in the community with developers that are willing to invest."

Even getting to Rochester is a challenge, Brede said.

Rochester's airport has direct flights, but only from Chicago and Minneapolis. While there is still hope for a high-speed rail connection to the Twin Cities, it could be decades before that happens.

The "satisfaction gap" also exists for Mayo employees. And that's a challenge when trying to recruit employees to come to Rochester.

Jeff Jensen manages Express Employment Professionals, a recruitment firm in Rochester. Many times Mayo is its own worst enemy when trying to attract top talent, he said.

That's because the city lacks a diverse job market. The decision to relocate here often comes down to what options are available for a spouse or significant other.

In this photo taken Thursday, June 14, 2012, pedestrians cross the street in downtown Rochester while Mayo Clinic's Plummer Building can be seen behind them, Mayo Clinic, Minnesota's largest private employer, is expecting more growth over the next few years as people live longer and need more care. That's also good for businesses like rental apartments, hotels and transportation services, which can thrive off a larger population. Alex Kolyer for MPR

"Sometimes they may really love Mayo Clinic and they might like Rochester or a lot of things about it," Jensen said, "but the fact that we just can't have an opportunity for both — but yet going to Baltimore, maybe then both people can extend their careers and have opportunities there. So that's where a lot of times I think we lose out."

Rochester is a good fit for many candidates, Jensen said. The city has good schools, a low crime rate, and it's easy to get around.

For others, Rochester's size makes it a poor fit.

"There are candidates that just would rather be in a bigger city and Rochester is just not going to be a fit for them," Jensen said.

In 2009, Mayo employee Bobby Davis, 38, and his girlfriend moved to Rochester from Phoenix after he landed a dream job as a user interface designer for web and mobile devices.

"We had heard some of the rumblings about how there's nothing to do and we dismissed all that," Davis said. "We said, 'No, we're going to get out, we're going to ski, snowshoe. We're going to get out into nature and take pictures.' And we did all that. And that was fun for about six to eight months."

The mid-sized city was charming at first, Davis said, but it never fully compensated for its lack of urban lifestyle. He returned to Arizona but continues to work remotely for Mayo's Rochester campus.

"I plan to retire from Mayo. It's definitely the best job I've ever had as far as opportunities and I love the work," Davis said. "But unfortunately, Rochester killed it for me. I just didn't want to be in Rochester anymore."

Davis says location will continue to be Mayo's biggest challenge. But to become a medical destination point, the city and the clinic will need to make Rochester a place more people want to call home.