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Is it possible to work outside of academia for several years, then go to a fellowship with the intention of re-entry?
I'd argue it's not only possible, but almost certainly a smarter financial decision too. You'd almost certainly make more in PP building up that nest egg for 5-10 years. Then go back and do a fellowship, which is not hard to get into, to hop back into academia. Chances are you won't be welcomed into name brand places like MGH or Columbia unless you were doing significant research in PP, but where I'm at I think they'd consider anyone for a position if they had the experience for it.
Depending on the fellowship, even top names are possible. One of the least intelligent physicians that I’ve ever met did a fellowship at MGH. CV was trash up to that point. Even the big names sometimes just need a body.
Sure, as long as they don't disagree with me is all.You wouldn't need to worry about competiveness per se and I would expect plenty of interviews; the concern you would need to be prepared to address would be if you can tolerate going from being an independent attending back to being a trainee and having your decisions scruitinized or approved by others, including those who may have less overall experience than you do. Some places may ask you outright about this dynamic and others might not, but they'll be thinking about it and looking to your interview to assess it.