So...I am not trying to discourage you, but I am going to provide a bit insight of what I know of: 2 of the 3 programs in my area do not take or interview step 1 <240, since about 3 years ago. I do not know about program #3 but i suspect the same. This is from speaking to the program directors/residents, and also from interviewing applicants for the admission selection committee. I however did not check on what programs in other regions are doing. I think you should apply wide and many and hope for the best, but be prepared to have a back up plan in case things dont work out. Being picky about where to go to is probably not a luxury for you, and if you are not from the west coast or have connections, i think that will be quite challenging to go there. Maybe you have impressive research, lots of activities, or a personality that shines during the interview, these are certainly excellent attributes that will compensate very well.