A sub-200 Step 1 may auto-screen you out of a lot of places. EM is getting competitive with each year. I'll echo the advice above, take Step 2 early (like July), but make sure you are ready for it. Once you hit 240-250, it gets easier to overlook a poor Step 1 performance. Additionally, I would do an away rotation (or 2) and impress the hell out of them. First-hand knowledge of you and your ability will make it easier for PDs to see past a test score. Good luck!