I will have to disagree that PMR trained doctors are best interventional docs. I would say that its anesthesia by quite a distance simply because of the nature of our training. At least in my experience.
There is a reason why >85% of sponsoring pain medicine fellowships are through anesthesia. And the simple reason is, because in order to be a true pain medicine consultant, one must have mastery over managing pain in an admitted patient and manage peri-operative pain. This is where anesthesiologists excel, like PCA management, regional blocks, opiate titration etc. In the near future, this will become a big deal (it already is becoming) as more and more hospitals are realizing the importance of revenue being tied to inpatient pain control and how significant of an impact this has to the hospitals bottom line, HCAPS scores etc. Discharge times are closely linked to good pain control and coordination of care post-op.
PMR is the same amount as anesthesia in terms of residency years - so I am not sure if one will save time.
However, where anesthesia based pain docs lack, is 1) physical examination and diagnosis skills to actually manage the patient and work on treatment protocols, and ALL fellows should be making this a priority as opposed to worrying about how many stim trial they will do. 2) Documentation which is respected by colleagues, and clearly lays out the thought process behind your choice of intervention - simply anesthesia trained docs arent the greatest in writing notes...IMHo
The latter two can be learned and worked on, but it takes time - I highly recommend Waldman's common pain syndromes book. I also made protocols for myself based on diagnosis that I am not really familiar with, just to make sure I practice in an evidence based manner, like Fibromyalgia rx: a) really question the dx, b) no opiates, c) CBT, d) anti neuopathic pain meds e) low threshold for referral to psych + rheum f) accupuncture/ massage/ weight loss/ physical therapy, etc etc. Not every pain syndrome encountered will be low back pain or neck pain...
As the most effective model is multidisciplinary, I had to learn things that were outside the usual scope of anesthesia. But in all honesty, I think anesthesia trained docs are much superior in manual dexterity and speed at which procedures can be performed since the training is such, i.e. epidurals, catheters, nerve blocks etc. The familiarity with needles, equipment and exposure to manage acute pain etc is unmatched vs. neurology and PMR.
