I have not heard of fellowship interviews requiring a talk (but apparently some do). Almost all academic jobs are associated with a talk. I'm doubtful that private practice jobs have time for a talk.
My reaction to giving a talk for a job or fellowship interview is:
1. Go for it. You need to shine brighter than anybody else. I have found that giving an outstanding talk gives you brownie points like few other things. Being able to present in front of your peers is important for all physicians. At tumor boards, pathologists are consistently required to project their knowledge and expertise. They need to explain nuances. Doing this well inspires confidence and trust in your abilities. It earns you street-cred like nothing else. If you are facing competition in the job market, you want to flaunt your assets.
2. It's the same reason you shouldn't shy from slide tests. If you know your stuff, you will sail through the slide tests. If you double scope, you can even share your approach and train of thought with potential employers. This is another opportunity to distinguish yourself from others and be impressive (in an appropriate way; not cocky).