My advice: Do a fellowship for the experience. Makes a difference. I've hired straight AP / CP and fellowship trained pathologists in private practice and would only hire fellowship trained in the future, hands down.
Private practice you need to be AP/CP certified to be a medical director. If you can't do that, a lovely option is to hide in academics looking a the few GI biopsies that straggle in.
Politics in both places can be a nightmare. Choose wisely.
Always have plan B and C on hand.
Read some of LaDoc's and other's posts on this as well as diversifying as a pathologist, they are insightful.
FYI, the local VA has 4 pathologists doing the workload I handle by myself. Beware if the VA is your first job, I would venture to say it should be an end game, but my 0.02