There’s a difference between what you can do and what you should do. Could you do pain procedures with only a PM&R residency under your belt? If you can get credentialed for it...absolutely. There are PM&R physicians who have been doing the procedures for decades before they even had fellowships and they do a good job. But realize that there is a shifting medicolegal landscape, credentialing is tightening up, and I think you have a responsibility to be competent when direct needles toward your patient’s spinal cord. I don’t personally feel comfortable with the liability, especially knowing that my patients have access to a competent pain training physician. If I lived in a remote area with poor access, my opinion would probably change.
Regarding, EMG...you should be competent to do EMG directly out of residency. Shoot..I had enough cases to fulfill my first part if board eligibility. It’s a low risk procedure. You will probably be better trained than the significant majority of Neuro residents. I’d get a fellowship if you want to do the high level procedures such as MEPS, single fiber, or diaphragm...especially if you want to go to an academic center.
Regarding ultrasound...there are a ton of people without decent formal training doing ultrasound guided procedures. The learning curve is very steep...have a very high level of skepticism regarding prospective residency programs ultrasound training. Few programs will allow you to be competent after finishing residency. You could be credentialed for doing your 10-20 injections...but you won’t be good. Residents who tell you they are great at ultrasound are probably naive. With that said...there are some programs that are very good at ultrasound...perhaps better than most sports fellowships. If you go to one of those programs, you don’t need a fellowship (though it certainly doesn’t hurt). If you plan on using ultrasound heavily for ultrasound diagnostics, I’d recommend one of the handful of sports fellowships that train that skillset well...because liability raises with diagnostics.