The PANCE, or Physician Assistant National Certifying Exam, is the certification test that physician assistant (PA) graduates must pass before they can practice medicine. Administered by the National Commission on Certification of Physician Assistants (NCCPA), it consists of 300 multiple-choice questions covering the full scope of medical knowledge a new PA needs on the job. Passing it is a requirement for licensure in all 50 states.
Exam Format and Timing
The PANCE is a five-hour, computer-based exam taken at a Pearson VUE testing center. Those 300 questions are split into five blocks of 60 questions each, and you get 60 minutes per block. Between blocks, you have a total of 45 minutes of break time to use however you choose. There’s also a 15-minute tutorial at the start to familiarize yourself with the testing software before the clock begins.
Every question is multiple choice. There are no essays, clinical simulations, or oral components. The questions present clinical scenarios and ask you to identify a diagnosis, choose the right treatment, or interpret a lab result.
What the Exam Covers
The NCCPA publishes a content blueprint that breaks the exam into organ systems and clinical task categories. Medical content makes up 94% of the test, with the remaining 6% focused on professional practice topics like ethics, patient safety, and teamwork.
The heaviest organ system categories on the current blueprint (effective January 2025) are cardiovascular (11%), pulmonary (9%), gastrointestinal/nutrition (8%), and musculoskeletal (8%). Other significant areas include infectious diseases (7%), neurology (7%), psychiatry/behavioral science (7%), and reproductive health (7%). Smaller but still tested categories include endocrine (6%), eyes/ears/nose/throat (6%), hematology (5%), renal (5%), dermatology (4%), and genitourinary (4%).
Beyond organ systems, each question also tests a specific clinical skill. The biggest slice goes to formulating the most likely diagnosis (18%), followed by history taking and physical examination (16%), clinical intervention (16%), and pharmaceutical therapeutics (15%). The remaining questions cover health maintenance and patient education (11%), diagnostic and laboratory studies (10%), and basic science concepts (8%). Roughly 8% to 10% of the exam covers surgical topics, and 12% to 15% of questions focus on pediatric conditions.
Scoring and Passing
PANCE scores are reported on a scale from 200 to 800, and the minimum passing score is 350. Not all 300 questions count toward your final score; some are unscored “pretest” items being evaluated for future exams. You won’t know which ones those are, so you need to treat every question seriously. Results typically arrive within a few weeks of your test date.
The national first-time pass rate is high. In 2025, 91.5% of the 13,145 first-time test takers passed. That number reflects how well PA programs prepare their graduates, but it also means that roughly 1 in 12 candidates does not pass on the first attempt.
Eligibility and Registration
To sit for the PANCE, you must be a graduate of a PA program accredited by the Accreditation Review Commission on Education for the Physician Assistant (ARC-PA). The NCCPA begins accepting applications 180 days before your expected program completion date, and the earliest you can actually take the test is seven days after your program confirms your graduation.
Registration costs $550. Once your application is processed and your graduation is confirmed, you receive a 180-day testing window. You can schedule your exam for any available date at a Pearson VUE center within that window. If you don’t pass, you can retake the exam, but there are limits on how many attempts you get and how long after graduation you remain eligible.
How the PANCE Differs From PANRE
The PANCE is a one-time certification exam for new graduates. Once you pass and begin practicing, you’ll eventually need to take the PANRE (Physician Assistant National Recertifying Exam) to maintain your certification over time. Think of the PANCE as your entry ticket and the PANRE as the renewal process. The two exams cover similar medical content, but the PANRE is part of an ongoing maintenance-of-certification cycle that includes continuing education requirements.
Preparing for the Exam
Most PA students begin dedicated PANCE preparation during the final months of their clinical rotations. Because the exam is broad rather than deep, covering 15 organ system categories across multiple clinical tasks, the most common strategy is using question banks that mirror the blueprint’s format and content distribution. Spending more study time on cardiovascular, pulmonary, and GI topics makes sense given their combined weight of nearly 30% of the exam.
Practice exams that simulate the block structure (60 questions in 60 minutes) help with pacing. At one minute per question on average, you don’t have much time to deliberate, so familiarity with the question style matters. Many candidates also use the NCCPA’s own practice exam, called the PACKRAT, which their PA programs may offer during training.
Your 180-day testing window gives you flexibility, but most candidates aim to take the exam within a few weeks of graduation while clinical knowledge is still fresh. Waiting several months can make the material harder to recall, particularly for rotations you completed early in your clinical year.