I am looking for advice on starting a pain practice without fellowship after completing anesthesia training VS. foregoing remaining 1 1/2 years of anesthesia training and doing pain fellowship now (am already board certified in emergency medicine)
This is just my opinion, but I don't think a residency in anesthesiology (or neuro or PM&R and certainly not IM, EM, FM, etc.) really prepares you for life as a pain physician. It's such a unique subspecilty that you really need the training provided during fellowship. Now having said that, there are plenty of pain physicians who didn't receive fellowship training, but for the most part, it was because no fellowships were available (ours is a very young subspecialty). However, there are no short cuts and I'm sure they spent just as much, if not more, time and effort into educating themselves. I'll bet most of them would tell you to do the fellowship.
Also, some facilities (for example...my hospital) now require fellowship training just to get privileges. Additionally, I know of at least one insurer who requires not just fellowship training, but ACGME fellowship training. I only found out because this particular carrier was refusing to add me to their approved provider list because "my fellowship wasn't ACGME accredited". Of course, they were wrong. I gave them the documentation they asked for and by the end of the day I was on their list, but it's pretty obvious it was a policy designed to decrease expenditures for interventional procedures.
As to the other question about doing a fellowship now, yes, fellowships are now "open" to everyone, but that doesn't mean very much. The competition is fierce and you must be a competitive candidate. I could be wrong, but I think you'll have a very hard time obtaining a fellowship without completing your anesthesia residency.
