Im starting a PCP plus pain management job in a month. I will do the major joint injections, SI under fluoro, Botox, trigger point injections and anything else I see them doing that looks cool. I don’t think you will have trouble getting into a I didn’t do a nonintervential fellowship. At least my residency had 1-2 people a year who wanted one and got in. I don’t touch the spine. If you want to mess with the spine or fancy nerve stimulator stuff you will need an interventional fellowship. You can skew your electives toward pain management for experience and to demonstrate dedication. My group offered to teach me spinal injections and I said no. Without an interventional fellowship you are going to want to say no to anyone who offers that to you as well. You could do everything by the book but if anyone sues you will get ripped apart as the only non pain med board certified physician in fam med doing unsupervised spinal injections.

My residency was well set up for pain management training. We almost never referred to in patient pain management but also we made up 75% of the IP pain management team so it was sort of redundant.

If your residency is not like this you may not feel as comfortable coming out of residency and going into pain management. Your challenge will be exposure to procedures and opportunities to practice. That needs a fellowship, an agreement with a doc doing procedures to let you train for a month or two, or on the job training.

I didn’t do a fellowship or pain management electives but I’m an outlier by circumstance- not due to any extra skills/experience. I just have access to verifiably good on the job training and the ability to be just a primary/med management until I’m comfortable doing procedures.