For the third time in my career as a Physician I have been replaced by a Nurse Practitioner, seemingly becoming an acceptable trend. And as I have done in the past I will report my concerns, that it is in large part a leading cause of medical errors, a provider without a medical license. And for this service, your visit is not subject to a reduction in payment, as you have been provided a significant reduction in the level of expertise, you are billed as well as your health insurance, for the same level of care, as if seen by a licensed physician, with 8 years of training. I have witnessed the mistakes first hand, in nursing homes, and offices, the irreversible mistakes that so often goes unnoticed, so easily covered up with a ton of unacceptable excuses. The tragic results affect even those with adequate health insurance, leading to increased ER visits, and hospital admissions which clearly equal an increase in premiums to cover the inadequate initial clinical impressions, as to how this patient is to be evaluated and treated.