Great board scores and grades will always GET you an INTERVIEW. They DON'T GUARANTEE snything. I've seen lots of students get an interview in ophthalmology, orthopedics, radiology, and surgery with board scores in the 180-200 range (minus 1 standard deviation to mean) and class standing in the 3rd or 4th quarter of the class. Those people worked hard in their 3rd year, kissed ass, and MOST OF ALL, in my opinion, RESEMBLED PHYSICALLY AND IN MANNERISMS, PERSONALITY, DRESS, ETC., ATTENDINGS AND RESIDENTS ALREADY IN THOSE SPECIALITIES.
One of my close friends got a 180 on Step 1, failed Step 2 once before getting a 181, and was 194/205 in the class. He got a top ophthalmology spot. But he was a classy dresser, "looked like an ophthalmologist", ordered gourmet dinners delivered to his team when on call (my idea for him), and "sounded intelligent". He privately admits to me, now that he's in his 3rd year of ophthalmology, that he's completely outclassed by his peers, and that he's considering switching to FP because he feels like he's just not talented enough to not make mistakes. He's very uncomfortable with any surgery. When he got ophthalmology, we felt like the joke was on the system. Now, he feels like the joke is on him. I wish I had advised him to take something that he could do well.
I have another close friend who failed 2 years which he repeated, barely passing. He failed Step 1 twice, finally passing the 3rd time with a 183. He failed Step 2 the first time (after he got matched in March of that year, so no one knew it was going to be a failure) and has never taken Step 2 again yet. He got emergency medicine in one of the very best programs in the country. Why? Because he was the ultimate scutmaster on his 3rd year and 4th year guest rotations in trauma. EM. and surgery. He is closing in on finishing his 4 year program in EM, and is worried about how to pass Step 2 first. Yet, in his case, he really is a terrifically gifted EM doc. I'd trust my life to him anytime.
Now, there are also lots of smart people with high boards and high grades who have gotten ortho, ophthal, ENT, radiology and the like. But the above stories go to show that there are flagrant exceptions to the rule, and that nothing is certain.
My final story: When I tried to get radiology with my Step 1 = 246 and Step 2 = 248 and top 5-%ile class standing, I got knocked out in the 2 programs that I applied for by students from my school ranking 120/205 and 138/205, that had board scores on both I and II of 198-205. (It was common knowledge that such programs try to take only 1 person from each med school to achieve "balance".) One of them was a terrific golfer; he used that to socialize when he was doing a guest 4th year rotation at the program that took him. The other "looked and talked like a radiologist already" according to the program that took him. We were both at a lunch with radiology when they said that about him. I visit them occasionally to help them read films, and yet I'm out for a year doing research.
My biggest 2 mistakes: assuming that my terrific academic profile would guarantee me either of the 2 programs, and then only applying to the 2. I'll apply to 15 next time.
Perhaps the other thing to remember is this: I don't choose my friends based on their grades and boards, and perhaps residencies think the same way. I'm taking golf lessons as insurance.