Here's the take from a coordinator and I know my PD pretty well, so I can say with pretty absolute certainty that this is their take as well.
No matter what anyone says, Anesthesia IS competitive. Last year we had nearly 700 applications for 7 positions (a 64% increase since I started five years ago). We can only interview about 100 people, so we comb over applications with a microscope. An unexplained or "glossed over" break in med school, a less than complimentary remark on a Dean's letter, an indication that "MS4 Jones" doesn't play nice in the sandbox, a dramatic drop from Step 1 to Step 2 (20 points or more), ANY failure on any level of the Step (or COMLEX) exams--all of these are factors (read: RED FLAGS) that could quickly cause your application to land in the "not selected" pile. Last year we filled long before the half-way point on our match list of about 90 people. (Board certification rate is part of any program's review criteria for ACGME accreditation so failure of any level of Step or COMLEX exams will cause a program director to be concerned about your test-taking ability.)
It's critical that you make the right impression during the interview too, if you're fortunate enough to be invited (not just to my school but anywhere). If you spend the entire day talking to your buddy from your school who chose the same interview day as you instead of making an effort to get to know the faculty and residents, you've blown it.
And this I say for myself. I can't say what happens at other schools, but I can tell you that at my program, I have a voice in the selection process too. I may not be able to judge you clinically, but I can certainly say whether you're "nice" or not. I can often get a pretty quick read (through the scheduling process, etc.) on who will likely be "high maintenance". Of course my PD and chair have the final say so, but my input is weighed equally.
Your input is certainly appreciated, and I don't doubt one word of what you're reporting here, but I also don't want your post to contribute to more unnecessary mass hysteria. Just a few points...
1) There might be 700 applicants for 7 positions (it sounds like you have an exceptionally popular program), but
the quality of those 700 applicants matters a ton. Check the average board scores and AOA status of successful anesthesiology applicants and you'll see that they're on the lower end of the spectrum.
2) Not every program is going to have 700 applicants for 7 positions. There are a ton of positions in anesthesiology to go around (unlike the truly competitive fields like derm, plastics, oto), making it easy to match. It may very well still be hard to match in any given specific program, however, so it's to everyone's benefit to apply broadly.
3) The 20 point drop you're talking about from Step I to Step II would be a big deal if you were talking about a red flag being raised after a change from 260 -> 240, but that's probably not the case here. Your program would be crazy to eliminate such candidates provided they have no other glaring deficiencies.
4) Re: having someone fail one of the step exams and having this be a key factor in eliminating someone's candidacy - this is the case at any respectable program in almost any specialty.
5) Your interview criteria can be applied to any specialty and doesn't single anesthesiology out. Residency directors in every specialty are going to want hardworking, socially normal people who are easy to get along with.
If the point of your post is to emphasize that you can't be a socially awkward doofus with red flags and expect to match in anesthesiology, then I agree with you're assessment entirely. Again, your point of view as an insider is appreciated, but I think it deserves to be interpreted in the right context.
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