Assuming you're an AMG, you'll be fine. IM is really only super competitive at the very top (top being a very relative place depending on your career goals and whether or not you want to do academics in the future). Maybe you won't get any love from Brigham or Hopkins, but you'll get plenty of love elsewhere, especially with a 240 step 1 and some decent LORs. Try to do well for the rest of the year and snag some honors. I'd say to honor your subI, but sometimes life just doesn't work out the way you planned.
Goal programs don't change because you think you're less than competitive. The fastest way to lose a chance at the top programs is to never apply. Besides it's only 8 bucks a program.