Nah jk, I would definitely make sure you can do the important procedures by yourself. The way our rotations are setup, we had to solo cover night float starting from day 1 of fellowship, and while anesthesia can intubate your patients for you, all lines needed to be placed at night by you, so of course you needed to be sure you knew how to do those.
You're a subspecialty consultant now, not an internist. There's a reason we refer back to primary care and/or onward to other specialties instead of handling problem ourselves (heart failure, renal failure, diabetes, etc.).
Yes. There is every possible combination out there. PCCM has enough demand that you can do pure CCM, pure pulm outpatient, or pulmonary inpatient/outpatient. If you do a sleep fellowship than you can do a pulm/sleep combo. Or pulm/sleep/cc. I’ve even seen someone who practices only sleep and CCM, no pulm.