These types of questions are best answered by your home school program director. Or you could meet with a program director at an allopathic university and ask what he or she thinks. You probably will not be able to get an interview at most of the top IM programs with that particular USMLE score because I've been informed that a secretary actually goes through applications and screens applicants by grades and scores before anyone even offers an interview. Sometimes, they don't even look at your app until you arrive for an interview, so it's tough to have really strong evals compensate for your overall application when that happens. If you are top of your class and have strong letters of recc, I don't suspect that you will have a problem in matching into a strong program. Even if you aren't, I don't imagine that you would have too much difficulty matching into a decent university IM program simply because there are so many out there. As far as fellowships go, if you work hard during your internship year and are able to secure some nice LOR's, I don't anticipate that you will have a problem there either. Even though nephro and heme onc have been getting more competetive lately (as everyone and their mother wants to do a specialty), heme onc and nephro aren't nearly as competetive to get as cardio or GI. Research would also help you get your foot into the door too. I predict that heme onc will bottom out in a few years when this whole medicare and chemo reimbursement issue bottoms out heme onc's salary too. Right now, it's a very profitable field as evidence by the number of new fancy cancer centers going up. But since competetive roughly correlates with salary, if heme onc is hit hard by these new reforms, I wouldn't be surprised to see if they see their total number of applicants drop substantially. It's difficult to predict though, these things change so quickly these days.
Thanx again.