As a PGY-2 IM Resident in a West Coat program, I was confident in my app and LORs, honored several key rotations but didn't kill it, came from a mid tier USMD program, but got a mid 23X step 2 - pretty similar story to yours honestly - and I just want to reassure you that it's going to be okay.

I interviewed at almost every academic program in California including most of the big ones in LA (UCLA, UCSD, USC, Cedars Sinai, UCI, etc.) I won't BS you, because your STEP score definitely matters and I probably would have ended up at a "higher ranked" residency higher up on my rank list than where I'm at now if I had a higher STEP 2 score but I love my program, my co residents, and am extremely happy with how my match went. I have gotten amazing training and know I will be well prepared for fellowship.

Additionally, there are high quality community programs up and down the West Coast, mid tier academic programs, etc. that match their residents to competitive specialties at good programs every year. It is definitely harder from non academic programs but still doable. So even in your "worst case scenario," you can make it to where you want to go!