CONFLUENCE -- It's just a double-wide trailer on the eastern bank of the Youghiogheny River. Sixteen hundred square feet of examining rooms, with no lab, no radiology and, on most days, no doctor.

But for the town of Confluence, a Somerset County community of 800 people two miles upstream from the southeastern edge of Ohiopyle State Park, the Confluence Health Center is the only provider of health care.

Separated from Uniontown and Somerset medical facilities by 25 miles of serpentine roads, the clinic's elderly patients, most of them lacking transportation, have come to rely on its small staff to check their blood pressure and blood sugar, to write prescriptions and make referrals.

So the news that Confluence Health Center will close permanently, effective March 17, has alarmed and saddened the citizenry.

The center's sole physician, Dr. Dwayne Platt, left Confluence in July. And, after a 10-month national search, officials with Conemaugh Health Initiatives, the for-profit entity of Conemaugh Health System, which owns and operates the center, have been unable to recruit a successor.

It is a common story in rural medicine. Many rural areas suffer a shortage of doctors. Like them, Confluence is designated by the state and federal government as a "health professional shortage area," which offers doctors signing bonuses or student loan forgiveness in return for a two- or three-year commitment to practice in poor urban or rural areas.

There are two physician vacancies in the family health care center in Meyersdale, about 25 miles east of Confluence, and one vacancy in Somerset, said Elaine Lambert, president of Conemaugh Health Initiatives. Somerset Hospital's clinic in Confluence closed in July 2004.

Despite offers of more generous compensation, increased signing bonuses and student loan forgiveness programs, all 10 candidates interviewed for the position at Confluence Health Center declined to accept it, Ms. Lambert said. That short list included those with roots in the area, even those emerging from Conemaugh's own residency program.

A number of factors seem to be working against Confluence Health Center, Ms. Lambert said. They include the remoteness of the community, so named for its being at the junction of the Youghiogheny River, Casselman River and Laurel Hill Creek, and the clinic's lack of a group practice with senior physicians to offer feedback and guidance.

"Confluence is a great little community," Ms. Lambert said. "It's just very, very hard to recruit. Money doesn't seem to be the answer."

In the meantime, patients of the Confluence Health Center have been leaving in droves, exasperated with the series of temporary "rent-a-docs," or locum tenens, that Conemaugh found through national agencies to fill in. One young doctor was committed to stay at the center through March, Ms. Lambert said. She left just before Christmas, with only three days' notice. For the next month, the center operated without a physician.

When patients' prescription refills became a problem, a physician from Jennerstown, an hour away, would occasionally stop in at night and review paperwork or do consultations over the phone.

Rather than put patients at risk, Ms. Lambert said, Conemaugh Health Initiatives made the decision to close. As of a few months ago, the center had between 1,500 and 1,700 "active" patients, people who had been seen within the past two years.

But some people say patients already have been put at risk. With temporary doctors making infrequent appearances at the Confluence Health Center, patients could get their blood drawn and checked only on certain days of the week, said Loretta Thomas, of Ursina.

Mrs. Thomas' father, Kenneth Rugg, the longtime mayor of Ursina, was taking the blood thinner Coumadin for blood clots, a therapy which requires regular blood testing. He was on his way to get his blood checked when he slipped on an icy sidewalk and suffered a broken hip. The injury touched off a health crisis, and Mr. Rugg died a few days before Christmas.

Mrs. Thomas can't help thinking that if her father had been able to go into the health center on another day, a better day, the accident might not have happened.

"You had to go whenever somebody was in," she said, wiping away tears.

On a recent Monday morning, 30 people waited to get their blood checked, but snowy roads kept the doctors from making the trip to Confluence. The patients were turned away, said John Tressler, president of Confluence Borough Council, who is trying to find a way to keep the center open. He has contacted the Pennsylvania Office of Rural Health, Uniontown Hospital, the University of Pittsburgh Medical Center, West Virginia University and several other health care entities, but said he had received no response.

"The problem is: Where are they all going to go come March 17?" said Mr. Tressler, who manages a local fuel company. "A lot of the older people will just say, 'To hell with it,' and not take their pills."

Many Confluence residents and community leaders are protesting Conemaugh's decision. They argue that the Confluence Health Center is the only health-care provider in a town which, a decade ago, supported three doctors. The center also draws patients from other south-central Pennsylvania towns such as Ohiopyle, Addison, Markleysburg, Mill Run, and, just over the border, Friendsville, Md.

For the significant older population, the only transportation is a shuttle van that heads to Uniontown and Somerset for shopping a handful of times each month, said Ray Silbaugh, part owner of Confluence Hardware and Sisters' Cafe.

Mr. Silbaugh, president of Yough Housing, a 40-unit senior-citizen housing complex, is circulating a petition around town in support of keeping the Confluence Health Center open. Community members will picket in front of the center Saturday morning, Mr. Silbaugh said.

Confluence is on the outer fringe of Conemaugh's service area, and community leaders believe that patients are being penalized for taking their referrals to the more conveniently located Somerset rather than making the 60-mile trip to Conemaugh's Memorial Medical Center in Johnstown.

"If we didn't have Somerset Hospital sitting in between us, we wouldn't be having this conversation," Mr. Tressler said.

Ms. Lambert stressed that the decision to close Confluence Health Center was neither a financial nor a political decision. But it is a permanent one.

"It certainly seems like the Somerset and Conemaugh organizations are washing their hands of this area," said Bob Edwards, Mr. Silbaugh's business partner.