I'm sure it's somewhat regional, but I'm told by one of our board-certified ECC docs here that it isn't (at the moment) necessary. I've been considering it, and I don't want to do an internship/residency (nothing against them - if I were younger I'd be more interested). He told me it was absolutely no big deal and that if you don't want to go the internship/residency route (and ECC is one where you can do an ECC-specific internship rather than the typical rotating internship) you go out into GP, moonlight doing ECC work for a year or so, and then you'd have no trouble getting a job. He did say it would be difficult (at least in our area) to go <straight> from graduation into ECC work. But one year ... meh, big deal.
No idea how accurate he is, but a) he's an ECC doc who probably has his fingers on the pulse of that niche, and b) he worked in private practice ECC work prior to coming to our teaching hospital. All in all, I'd say he's likely to know more about it than most of us.
