I got some very good advice when I changed my preferences from a different specialty to Ortho. You've gotta remember that the top applicants will honor every pre-clinical class, honor every rotation, get a 240+ on their boards, be published, AOA, etc. There aren't THAT many applicants with all of these things but that is the kind of applicant that the top programs are looking for. The farther down the applicant totem poll you are it means you'll need to do a couple of things:
- Apply to more programs
- be more realistic about the program you're going to end up at
- Take control of things you can change. This means getting useful, detailed letters of rec, doing well on Step 1 (if you haven't taken it), develop some good contacts. You've got to become more actively engaged in your CV then other people that "walk on water"
So no I don't think you're doomed, but you're going to have to apply to more programs and start to control the things you can still change with regard to your application
JMO so don't blast me.