Many programs don't use cutoff scores at all, except maybe as a starting point to start reviewing applications. Yes, EM is a competitive specialty. However, board scores aren't the only factor that predicts success for a resident. Your M3 clerkship grades are very important (especially IM and Surgery), as well as EM letters of recommendation (hopefully from an EM residency program).
There are very few all-around "awesome" candidates, who have great boards/grades/letters/personality/ etc. Most everyone else (probably 80-90% of candidates) are middle to upper-middle of the roaders. Very few people (faculty included) can "do it all". Some programs may like to "brag" about the cutoff scores they use, but a lot of that might just be urban legend. There is probably some regional variation on this (i.e., California programs tend to be fairly competitive, mostly because of geography. Why everyone wants to go there, I haven't a clue. Guess that's the sign of a diehard midwesterner).
I can't speak for all program directors, but most of us would much rather have a hard working, teachable, reliable resident with good interpersonal skills, who's academically average to above average, than an AOA resident who can't do the job clinically, is lazy, or pisses people off. Our grief factor goes way up with the latter, and it's usually not worth it.
I think most of us try to look at the whole applicant. Outstanding boards can make or break some candidates, but most programs want a relatively well-rounded person who they think will fit in well with the rest of the team. (That being said, if you've flunked boards or barely made it through med school, then you'll probably have a tough time).
The key for applicants is to find a program that fits their needs and where they will feel comfortable spending their 3-4 years of training.
Hope this helps. It's a complicated decision for programs and applicants alike.
Marc Squillante, DO
Director, EM Residency Program
OSF St. Francis Medical Center/ Univ. of Illinois College of Medicine @ Peoria, IL