I gotta disagree with you about the academic job thing as well as with recruiters.
If a recruiter asks if you had a fellowship, what exactly are they expecting? I've been out 8 years now and was in the mix just about the time fellowships started hitting their stride.
I did three years of residency and have a faculty appointment at the medical school. I treat Charcot, Sports injuries, peds and a good mix of all things podiatry and never did a fellowship.
I don't know of any residency programs that look for fellowship training to become a residency director. I don't even know if that's preferred at this point. The only academic requirement to become a residency director is to be Board Certified. You don't even need RRA certification to be a director for a 3 year program.
All things being equal, if a potential employer is only looking for credentials over what really matters, I'd run away from that employer screaming. Training means very little in that regard in the real world tbh. You can be the best trained 3 year RRA masterblaster with a Fellowship of the gods, but if you're a jerk, you won't last long.
That being said, what's a competitive job out there? Open up your own practice. Be your own boss. No one will care about your fellowship in that situation. If you're doing a fellowship to be more competitive in the job market, I'm afraid you've already missed the boat. You're a doctor. Do it for the love of what you do and go hang out your own shingle. It will be infinitely more satisfying when you make it.
Not everyone wants to hang their own shingle.
Not everyone wants to treat everything that walks thru the door.
I respect the person that cares enough about their potential patient population to get that extra year of training.
I think the reason that lots of pod residents are starting to look at fellowships is that our training is so intgrated with MDs. The attendings that I respected the most did a fellowship, they sacrificed for one more year, or 6 months for that extra training. The general orthos could have gone out and got jobs paying $300K or so, but spent another year making $50K or less potentially limiting their lifetime earning potential (see JBJS article on fellowships and earning potential - it is very interesting which ortho specialties pay in the long run) so they could be a specialist in something. They did not want to be the jack of all trades and master of none. Many of my podiatry aquaintances doing fellowships also attended highly integrated residencies where they worked closely with fellowship trained plastic surgeons and fellowship trained orthopedic surgeons. If this is the example you see and they are successful and accomplished surgeons, wouldn't you want to emmulate them?
The people that I chose to be my mentors based on their style as a surgeon and as a teacher were all fellowship trained. The plastic surgeon trained for 10 years... including internship, gen surg residency, plastic surg residency/fellowship.
The orthopedic congenital hand surgeon did 5 years of orthopedics residency 1 year of hand fellowship and 6 months of pediatric congenital hand fellowship. This was certainly not to expand the scope of practice. They do the entire upper extremity , but mostly the hand and forearm. They take no general call and do no general orthopedic cases on other parts of the body except maybe the occasional desyndacyly of the toes.
If these are the people that we are now training with it becomes second nature, the next thing to do, a fellowship.
During my second year I decided I would do a fellowship. This was very early in my 2nd year. The only other person to graduate from Inova and do a fellowship was John Steinberg. It was thought that if you graduate from Inova you don't need a fellowship. Yes, this is true, you do not need a fellowship, but I wanted one and was in the position to get it. Fellowships are not looking for the person they can help the most with their fellowship, they want the person who best represents them and does the best work, the most qualified. So it is less likely the person needing the most help that gets the fellowship. Since I was not close to graduating I had no idea if I thought I would be prepared to practice or not from residency. None of my senior residents seemed to be nervous about going out to practice and no one ever called after graduating to say, oh no... you need a fellowship.
After seeing fellowship trained surgeon, one after the other and learning from them, it just seemed like the next step.
I see nothing wrong with having a year more confidence and training under my belt. When I do go to work, I plan to work with residents and I would like to be confident enough to hand over the knife and trust that I can fix what they may screw-up. This was the difference that I saw between accomplished surgeons and not, doesn't matter specialty, but fellowship training ( I think) played a big roll.
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