I have an opportunity requiring a 2nd class. I was given the advice "Go ahead and get a first since that is your long term plan. Better to find out now then when you need it". I don't know if that is good advice or not but I have heard that from 2 different sources when inquiring about this.
Bryan, at our age we start to transition from "perfectly healthy" to "I have a few things going on that may or may not be an issue".
As a result, if you're going to try for a 1st class, I'd strongly suggest you pay your AME for a consult, where they do the full 1st workup, including EKG, but with no paperwork generated, no MedXPress, nothing. Gather the information for him, but don't even log in to MedXPress. I did that before I started my current job, where I also need a 1st class. He was able to tell me "Okay, I need a note saying this and this from your doctor about this issue, but this other one is not a problem", etc., etc. Then I was able to see my doctor, get the required documentation, and a month later saw my AME again for the "real" 1st class medical exam. Since everything was in order, it was easy and he issued it and there were no problems or delays.
It was worth it to me to essentially pay for two visits (although he actually cut me a discount on the consult, since "hey, I didn't have to do any paperwork!").
After that I've only gone in for normal visits since, but you can bet that if I have anything remotely an issue come up in the future, I'll be paying for another "consult"!