Academic reputation: MIR > Vandy. If you want to do academics, for MIR. For pp, esp in west coast, the story is different.
California is like an isolate island. The best jobs always go to local trainees. UCSF and Stanford in North Cali and UCLA and UCSD in South Cali with USC and UCI following them. You can break into these best jobs by switching from your second level job after a few years of practice, even if you are not able to get the best job right after fellowship. Portland and Seattle are a little more open to outsiders. Having said that, despite people complaining about tight market, you can always find a decent job in smaller cities of Washington state, Oregan or Central California or a "second-quality level OK job inside big cities.
If you like Nashville much more, go for it. Then try to find a fellowship in west coast, preferentially in the area that you are looking for a job. Though there is no guarantee, you should be fine. With this strategy, there should not be a significant difference between these two programs.
This is the priority that comes to my mind for success in job placement in west coast:
1- Doing residency and fellowship in West coast
2- Doing residency outside Cali and fellowship inside one of the Cali big programs. Probably the residency name is not as important here by itself. However, it may be important for finding a fellowship in one of the regional big programs.
3- Doing fellowship in a big place outside Cali like MGH or MIR or Hopkins.
4- Anything else.
I thing the difference between 3 and 4 is relatively remarkable.
