The PANCE (Physician Assistant National Certifying Exam) is the certification test that physician assistant graduates must pass before they can practice medicine. Administered by the National Commission on Certification of Physician Assistants (NCCPA), it’s a 300-question, multiple-choice exam covering the full range of medical knowledge a PA needs on day one. Think of it as the PA equivalent of the bar exam for lawyers or board exams for physicians.
Who Can Take the PANCE
To sit for the PANCE, you must graduate from a PA program accredited by the Accreditation Review Commission on Education for the Physician Assistant (ARC-PA). Your program needs to have been accredited at the time you enrolled, not necessarily at the time you graduate.
After graduating, you have a six-year window to pass the exam. During that window, you can attempt it up to six times total. Whichever limit you hit first, six attempts or six years, ends your eligibility. If you graduate and wait several years before your first attempt, you’re eating into that clock. Most candidates take the exam shortly after finishing their program, while the material is still fresh.
Exam Structure and Timing
The PANCE consists of 300 multiple-choice questions divided into five blocks of 60 questions each. You get one hour per block, so the total testing time is five hours. Between blocks, you have a combined 45 minutes of break time to use however you’d like.
Every question is a single-best-answer format. You’ll read a clinical scenario, a patient history, or a description of lab findings, then choose the most appropriate answer from the options provided. There are no essay questions, no practicals, and no oral components.
What the Exam Covers
The NCCPA publishes a content blueprint that breaks the exam into two overlapping frameworks: organ systems and clinical tasks. Medical content makes up 94% of the exam, with the remaining 6% covering professional practice topics like ethics, patient safety, and legal responsibilities.
The organ system breakdown gives you a clear picture of where to focus your study time. The heaviest categories are cardiovascular (11%), pulmonary (9%), gastrointestinal/nutrition (8%), and musculoskeletal (8%). Midrange topics include infectious diseases (7%), neurologic system (7%), psychiatry/behavioral science (7%), and reproductive system (7%). Lighter categories like dermatology and genitourinary each account for about 4%.
Layered on top of those organ systems are task categories that reflect what PAs actually do in practice:
- Formulating the most likely diagnosis: 18% of the exam
- History taking and physical examination: 16%
- Clinical intervention: 16%
- Pharmaceutical therapeutics: 15%
- Health maintenance, patient education, and preventive care: 11%
- Diagnostic and laboratory studies: 10%
- Basic scientific concepts: 8%
Roughly 8% to 10% of questions cover general surgical topics, and 12% to 15% focus on pediatric patients. These aren’t separate categories but are woven into the organ system questions. The NCCPA notes that exact percentages may shift slightly from one exam administration to the next, but the blueprint gives you a reliable study map.
Pass Rates
The PANCE has a consistently high first-time pass rate. In 2025, 91.5% of first-time test takers passed. That figure was 92.4% in 2024 and 92.0% in 2023. These numbers reflect first-time takers only. Repeat test takers historically pass at significantly lower rates, which is one reason most PA programs push students to prepare seriously for their first attempt.
A high national pass rate doesn’t mean the exam is easy. It means that accredited PA programs generally prepare their students well. If you look at pass rates by individual program, you’ll see meaningful variation, which is something worth researching when choosing a PA school.
How the Exam Is Scored
The PANCE uses a scaled scoring system. You’ll receive a score on a scale where 300 to 800 is the possible range, and 350 is the minimum passing score. The scaling accounts for slight differences in difficulty between exam versions, so a 350 on one test date represents the same level of competency as a 350 on another. You won’t know which individual questions you got right or wrong. Your score report will show your overall scaled score and whether you passed or failed, along with performance breakdowns by content area.
Registration and Test Day Logistics
You register for the PANCE through the NCCPA’s online portal. Your PA program will verify your graduation and eligibility, after which the NCCPA sends you an authorization to test. You then schedule your appointment at a Pearson VUE testing center, which operates locations across the country.
On test day, expect a secure testing environment. You’ll go through identity verification, store personal belongings in a locker, and sit at a computer workstation. No notes, phones, or study materials are allowed in the testing room. Scratch paper or a dry-erase board is provided for working through questions.
What Happens After You Pass
Passing the PANCE earns you the PA-C credential (Physician Assistant-Certified). This national certification is what allows you to apply for state licensure, prescribe medications, and practice as a PA. Certification isn’t permanent, though. You’ll need to maintain it through the NCCPA’s continuing certification process, which includes logging continuing medical education credits and periodically passing a recertification exam called the PANRE.
If you don’t pass on your first attempt, you can retake the exam within your six-year, six-attempt window. There’s typically a waiting period between attempts, and you’ll need to pay the registration fee again each time. Using your score report’s content area breakdown to identify weak spots makes retake preparation more targeted.
How to Prepare
Most candidates study for the PANCE over several months, often beginning during their final clinical rotations. Popular resources include question banks like Rosh Review, PANCE Prep Pearls, and the Kaplan PA review course. The NCCPA’s content blueprint is your single most important planning document, since it tells you exactly how many questions to expect on each topic.
Practice exams that simulate the five-block, timed format help build stamina. Sitting for 300 questions over five hours is mentally exhausting, and familiarity with the pacing reduces test-day anxiety. Many candidates aim to complete at least 2,000 to 3,000 practice questions during their study period, cycling through missed questions multiple times until the underlying concepts stick.