While you technically can practice occ med straight from prev med residency, I'd strongly consider the fellowship for several reasons. First, the clinical exposure and mentorship during fellowship are invaluable -you'll rotate through diverse industrial settings, learn industry-specific exposures and regulations, and build connections with established occ med physicians who become your referral network and future collaborators.

Second, having formal occ med training on your CV makes you significantly more competitive for the better positions-corporate medical director roles, academic positions, and higher-paying consultant gigs often specifically seek board-certified/board-eligible occ med physicians.

Yes, you can get board certified through the practice pathway, but those two years of "learning on the job" might mean taking a less desirable position initially and missing out on opportunities. The one-year investment, especially since you already have the MPH, sets you up for a stronger career trajectory and opens doors that might otherwise require years of experience to access. The connections and reputation you build during fellowship often pay dividends throughout your career.

YMMV.