Yes, off label prescribing is a huge part of practice. You have a toolbox and you use what is in your toolbox to find the right fit for your patient. If bean counters and AI are going to determine patient care and not the clinician, why the hell have a provider? Myself and some of my colleagues tried to warn others about where this was all headed when the ACA was passed. Of course we were not taken seriously. It has been incremental steps to essentially strip autonomy away from providers and turn us into robots following one size fits all treatment algorithms. The ICD codes are a minefield. I sidelined myself when the Rona hit. I still have my license, but trying to actually treat patients in this climate is next to impossible. I have been around long enough to know what it used to be like. The younger practitioners don't know anything different than this new system. Maybe someday when the madness is over, there will be room for us to bring some sanity back. Until then, I will find other places where I can be of service.