I am a new attending working in private practice pain group. I did a fellowship that is now unaccredited, but has a solid reputation because of who ran it and the fact that it used to be accredited by the ACGME for a long time. I did a wide variety of procedures including pump and stim implants, endoscopic procedures (attendings only for those), inpatient pain consults and the full range of bread and butter stuff. I also live in a state that accepts both ABIPP/ABPM as equivalent board certification in Pain medicine. I am very happy with my job so far in the first 3 months, and I am close to home in area that I like. I do not do inpatient consults in practice or take call. I work mostly 9-5/6 M-F and I am making more than my friends whom did sports fellowships and whom are doing general PM&R. I also am in a Pain only group, so I do not have to deal with surgeons as my boss which is also nice. I agree that I am comfortable managing pretty much any MSK issue that is non-surgical, and if you have decent MSK exposure in residency you should be able to do most of what sports docs do. That being said I recommend doing an accredited fellowship if possible for several reasons as noted above. The big one is that many hospitals and insurances will not credential you without an ACGME fellowship. Knowing this, many places including private practices will not be interested in hiring you, even in states that accept ABIPP/ABPM. Also many sport and spine places don't manage medications, and jobs that will want you to prescribe will want to see that you can safely manage those patients and are comfortable doing so. More than 90% of my patients are within the CDC guidelines, but every now and again I get someone on a very heavy dose of meds that I need to wean and you need to be able to do that without sending everyone into withdrawl. Also some don't know how to read an LCMS, which is usually easy as the companies lay what is in there out for you, but could be an issue if you miss stuff because you don't know what some of the metabolites are. Agree you can get a job in pretty much any setting with a pain fellowship, but could be limited with sports. In the end having the accredited fellowship may make your life much easier, especially if you want to live in a competitive job market. I was not able to find a job in my primary target area partially due to the accreditation issue, but I am not that far away which is ok for me, but may not be for you or your spouse if you have one. I reccommend applying to both accredited and unaccretited places though, as the application process has gotten very competitive and many good applicants don't match. Good luck.
