I humbly and respectfully disagree with the approaches taken by the previous posters.
Before you decide what you prefer to do for your residency, it's better to first think about if you can *get* a fellowship.
I am making the assumption that you want to do interventional pain, not chronic medical management (otherwise, you wouldn't be worried about gas's superiority in getting into the epidural space). there is always going to be a fair amount of the chronic med management stuff...maybe you could think of it as 2-3 days of clinic to generate 1 day's worth of procedures. if you don't want to do interventional pain you may not need to do a fellowship.
I say "what you can get" b/c through the pm&r route, even though you may be better qualified, it will be much, much harder to get a pain fellowship that trains you in non-injection preocedures (implantable stimulators, pumps, RF ablation, etc). and more than half of people who have matched into pm&r in the last couple of years say they want to do that. the recently matriculated residents are in general a much more competitive bunch than the graduating pmr residents, objectively shown by the increasing numbers required to match at better programs. so you will have to be much stronger than the current pmr pgy4s to get an interventional pain fellowship through pmr in 4 years.
regardless of who is more prepared, most interventional pain fellowships are run by anesthesia and prefer anesthesia (although they still take pmr folks, but fewer).
it doesn't matter that gas folks are more facile getting into the epidural space blind via loss of resistance technique...in practice you are going to do everything under flouro, and your fellowship will teach you all that. but there are a limited number of pmr-only fellowships, and they will be tougher and tougher to get.
i think rehab folks will probably be better pain docs, but if you know you want to do pain (and i think it's a reach to say the average 25 year old med student really knows they do...doing a rotation or 2 and getting excited by it isn't a good comparison to whether or not you want to do it when it's second nature and the chronic whiners start getting to you...plus a lot of the procedures/injections being done don't have overwhelming evidence as to their efficacy yet...check out any of the evidence-based reviews...neither does spinal surgery either, for that matter).
keep in mind that the majority of gas graduating gas residents that *can* get an interventional pain fellowship choose not to. the opposite is (probably) true for pm&r. is suggest you do some informal polling with some questions for pmr bound folks like "Are you interested in doing a fellowship to do more inteventional pain procedures?"
just the thoughts of a gas-bound intern who went down this road a year ago (i am also s/p laminectomy for back problems, so i kind of identify with the chronic whiners). hope this helps
neuropathic said:
If pain fellowships are still around in 4-5 years, it is likely that the training will be more than 1 year through anesthesia (1.5-2 years is the number throwing around). It is also possible, that pain will become an ABMS specialty, which means it will no longer be a fellowship, but you will do a full residency (perhaps 3-4 years).
To answer your question, if you like to put people to sleep, do procedures, interest in pharmacology, do gas; if you like rehab, musculoskeletal medicine, helping people to regain their function after illness/trauma, explore PM&R.
It's only going to get more competitive, as Medicine and Neuro try to get in on the procedures as well.
