True words of wisdom bedrock. The new generation of PM&R residents need to realize this but they are force feed from the first day of residency that a fellowship is a must.
I think the push for job vs. fellowship is program dependent. I know some places where most residents are not doing fellowships. At my institution, having additional fellowship training in pain, sports, brain injury, sci is almost an unspoken requirement. In fact, people have not been hired because they did a non-accredited interventional spine fellowship vs. an accredited pain one. Albeit I train at a highly academic institution, and I know people are doing all kinds of procedures right out of PMR residency.
I really do not know much about the future of regenerative Medicine for PMR and what the right answer is, but I think taking more than a few classes would be needed to do it well. Same with using ultrasound. We train heavily in US every 2-3 weeks for a 6 month block at my program and use this diagnostic and interventional tool thorough out our residency training. I think most of us feel comfortable using it in our practices when we are done but some want extra training in their sports, MSK, neuromuscular,and pain fellowships along with other skills before just doing it on practice. IMO someone who takes one or two MSK us course buys a machine and starts using it for everything without continued training and education could be a little cavalier or dangerous. It's more than just show me where to put the needle with this.
I think should be true with regenerative medicine but not sure what the answer is.
If you have aspirations to be a team doc and potentially work in academics fellowship is key IMHO.
If you want to put spinal cord stims and do advanced spine and pain procedures ... A pain fellowship is a must
I think you can do most bread and butter PMR procedures right out of residency but depends on the volume and quality of your training, which I know is not equal at all places.