I am from the west coast as well and I don't know how to assess the job market for Boston specifically. That being said, big cities tend to be more competitive and people tend to be fellowship trained. I would start looking at the AAN career center as a starting point, or see if you know anyone in that area who might be able to help. Regarding fellowships...I know it's a very personal decision but I tend to recommend you do one (with a purpose). In general it's 1 more year (2 if you go for neuroICU) and it will only help you when it comes to being competitive or bringing "more skills to the table" for both inpatient/outpatient jobs.
What I mean about doing one with a purpose is to focus it more on what you want to do. If you want to do more inpatient then perhaps stroke or Neuro ICU would serve you well. If you want only outpatient then movement disorders or neurophys might be more your bag...or hell, maybe you like MS. That being said I would never recommend doing a fellowship in something you don't like.
