PANCE (Physician Assistant National Certifying Exam)
NCCPA
Complete guide to passing the PANCE (Physician Assistant National Certifying Exam) exam on your first attempt.
$550
~93%
10 years (with ongoing requirements)
USA
NCCPA
$110k-$140k
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Complete Overview
The PANCE is the Physician Assistant National Certifying Examination, the single exam a PA program graduate must pass to become a Board Certified PA in the United States, and the application fee is $550 paid directly to NCCPA. The National Commission on Certification of Physician Assistants develops and owns the exam, and only graduates of an entry-level PA program accredited by the Accreditation Review Commission on Education for the Physician Assistant, known as ARC-PA, are eligible to apply.
The exam runs 300 questions across five blocks of 60 questions, with 60 minutes to complete each block. NCCPA allots a further 45 minutes of break time to be spent between blocks and 15 minutes to view the tutorial, and candidates manage their own break time. That gives five hours of testing inside a six-hour appointment, which is how NCCPA's Test Day page words it: the five-hour PANCE exam is five blocks of 60 questions, with the break time and the tutorial on top. NCCPA administers PANCE year round at more than 300 Pearson VUE testing centers. Every PANCE form contains both scored and pretest items, and NCCPA states that examinees have no way of distinguishing between the two.
Scores are reported on a scale from 200 to 800, and the passing score is 350. That cut score comes from a modified Angoff standard setting exercise in which a panel of practising Certified PAs judges, question by question, whether a just-qualified candidate would answer correctly, with the recommendation approved by the NCCPA Board of Directors. Because NCCPA equates forms through automated test assembly, the number of correct answers needed to reach 350 varies from one examinee to another. Results are typically released within about two weeks. Score reports include content area subscores with standard error bars, which NCCPA warns should be interpreted with caution because smaller content areas carry fewer questions and wider error.
The content blueprint effective January 2025 splits the exam along two dimensions. Medical content categories cover 14 organ systems and account for 94 percent of the exam, with Cardiovascular the largest at 11 percent. Task categories describe what the PA is being asked to do with that knowledge, from history taking through pharmaceutical therapeutics. Professional Practice is the one category coded outside the task dimension and makes up 6 percent. NCCPA also specifies that up to 8 to 10 percent of the exam covers general surgical topics and that 12 to 15 percent of questions concern conditions in paediatric patients.
Eligibility is time limited. Candidates who graduated from an ARC-PA accredited program on or after January 1, 2003 have six years from completing graduation requirements to pass, and a maximum of six attempts within that window. When either the six attempts or the six years run out, whichever comes first, eligibility is lost, and NCCPA states the only way to establish new eligibility is to complete an unabridged ARC-PA accredited program again. Within that window, PANCE may be taken only once in any 90-day period and no more than three times in a calendar year.
Why Get PANCE (Physician Assistant National Certifying Exam) Certified?
Passing PANCE is the gate to the PA-C and Physician Assistant-Certified marks, which NCCPA legally protects. All 50 states, the District of Columbia, the U.S. territories and the U.S. military rely on NCCPA certification as one criterion for employment, licensure or regulation of PAs.
The Bureau of Labor Statistics put the median annual wage for physician assistants at $133,260 in May 2024, with the lowest 10 percent under $95,240 and the highest 10 percent over $182,200. The credential is earned after a PA program rather than a residency.
One $550 application fee covers the exam attempt and a 180-day scheduling window. There is no separate exam-day fee to Pearson VUE.
Certification is generalist by design. The blueprint effective January 2025 spreads questions across 14 organ systems plus Professional Practice, so a Board Certified PA can move between specialties without recertifying in each one.
The credential runs on a 10-year maintenance cycle rather than an annual renewal. Within it, PAs log 100 CME credits per two-year cycle and pass either PANRE or PANRE-LA by the end of the 10th year.
NCCPA reports first-time pass performance publicly in its five-year pass rate document, giving PA programs and applicants a shared benchmark rather than an anecdotal one.
The six-years-six-attempts rule means a candidate who fails once still has substantial room to remediate, provided they respect the 90-day interval between attempts and the limit of three attempts per calendar year.
Exam Format & Structure
Duration
Five hours of testing time. NCCPA allots 60 minutes per block across five blocks, plus 45 minutes of total break time between blocks and 15 minutes for the tutorial, which makes the full appointment six hours. Candidates are responsible for managing their own break time.
Questions
300 questions, delivered as five blocks of 60. Each form contains both scored and pretest items, and NCCPA does not publish how many of the 300 are pretest. Examinees cannot tell the two apart.
Passing Score
350 on a scale running from 200 to 800. The cut score was set by a modified Angoff panel of practising Certified PAs and approved by the NCCPA Board of Directors. Because forms are equated for difficulty, NCCPA states the number of correct answers required to reach 350 varies from one examinee to another.
Question Types
- Single-best-answer multiple choice questions built on clinical vignettes
- Vignettes that supply patient age, presenting history, vital signs, physical examination findings and often laboratory values before asking the question
- Most published NCCPA sample items offer five lettered answer options, though some Professional Practice items offer four; NCCPA does not state a fixed number of options
- Stems commonly ask for the most likely diagnosis, the most appropriate initial diagnostic study, or the most appropriate next step
- Professional Practice items covering ethics, disclosure of medical error, documentation and interpretation of study statistics
- Both scored and pretest items appear on every form with no visual difference between them
Delivery Method
Proctored, in person, at more than 300 Pearson VUE testing centers in the United States. NCCPA does not offer PANCE as a remotely proctored exam. The application generates a 180-day window inside which the candidate schedules a single appointment.
Exam Domains & Topics
The largest task category on the exam. These items give a full vignette and ask which diagnosis best fits. Success depends on discriminating between conditions that share features, which is why NCCPA's own sample critiques spend most of their text explaining why the plausible wrong answer is wrong rather than why the right one is right.
Key Topics to Master:
- Differentiating conditions with overlapping presentations
- Reading demographic cues such as age, sex and race as diagnostic information
- Interpreting laboratory panels in the context of the history
- Recognising classic syndromes from a constellation of findings
- Weighing time course, onset and duration of symptoms
- Ruling out plausible alternatives before committing
- Recognising when a finding excludes a diagnosis outright
Items test what to ask, what to examine and what a specific manoeuvre or finding means. This category is spread across all 14 organ systems rather than concentrated in any one, and it includes recognising which elements of history change the management pathway rather than merely adding colour.
Key Topics to Master:
- Focused history taking by presenting complaint
- System-specific physical examination manoeuvres and their meaning
- Vital sign interpretation in context
- Recognising red flag findings that change urgency
- Age-appropriate examination technique for paediatric patients
- Distinguishing normal variants from pathology
- Documenting examination findings accurately
Non-pharmacological management: procedures, referral decisions, admission versus discharge, monitoring and follow-up. NCCPA's own sample questions include head injury disposition, where the correct answer is discharge with observation by a reliable adult because the patient meets none of the criteria for imaging or admission.
Key Topics to Master:
- Admission, observation and discharge criteria
- Procedural indications and contraindications
- Referral thresholds and specialist involvement
- Emergency stabilisation and resuscitation priorities
- Wound and injury management
- Follow-up intervals and monitoring plans
- Surgical topics, which NCCPA states cover up to 8 to 10 percent of the whole exam
Drug selection, dosing considerations, adverse effects, interactions and monitoring. Items frequently link back to the diagnosis, since choosing the right drug requires having already reached the right diagnosis. Adverse drug reactions also appear inside diagnostic items, as in NCCPA's sample question where a sulfa antibiotic precedes erythema nodosum.
Key Topics to Master:
- First-line drug selection by condition
- Adverse effects and drug-induced presentations
- Drug interactions and contraindications
- Antimicrobial selection and stewardship
- Monitoring parameters and therapeutic drug levels
- Dose adjustment in renal and hepatic impairment
- Pregnancy and paediatric prescribing considerations
- Analgesia and controlled substance prescribing
Screening intervals, immunisation, counselling and risk reduction. This category rewards knowing published guideline thresholds rather than clinical intuition, and it intersects with the paediatric content that NCCPA states makes up 12 to 15 percent of the exam.
Key Topics to Master:
- Cancer screening indications and intervals
- Adult and paediatric immunisation schedules
- Cardiovascular and metabolic risk factor modification
- Smoking cessation and substance use counselling
- Travel and occupational health prevention
- Prenatal and well-child preventive care
- Patient education for chronic disease self-management
Choosing the right test and interpreting the result. NCCPA sample items test whether a candidate selects the most appropriate initial study rather than the most definitive one, as with an exercise stress test over coronary arteriography in an asymptomatic patient with a normal electrocardiogram.
Key Topics to Master:
- Selecting the most appropriate initial diagnostic study
- Sensitivity, specificity and pretest probability in test choice
- Interpreting complete blood count, metabolic and endocrine panels
- Imaging modality selection and its contraindications
- Electrocardiography interpretation
- Recognising when a test is contraindicated or will obscure findings
- Confirmatory versus screening testing
Pathophysiology, anatomy, microbiology and pharmacology underpinning clinical decisions. Items in this category tend not to announce themselves; they appear as clinical vignettes whose correct answer depends on understanding a mechanism rather than recalling a guideline.
Key Topics to Master:
- Pathophysiology of common disease processes
- Anatomy relevant to physical examination and procedures
- Microbiology and mechanisms of infection
- Pharmacological mechanisms of action
- Fluid, electrolyte and acid-base physiology
- Immunology and inflammatory mechanisms
- Genetics and inherited disease mechanisms
The one category NCCPA codes outside the task dimension. It covers medical ethics, disclosure of error, scope of practice, documentation integrity, risk management and the statistics needed to read a clinical study. NCCPA's published sample items in this category include disclosing an embryo implantation error and refusing to chart an examination manoeuvre that was not performed.
Key Topics to Master:
- Disclosure of medical errors to patients
- Documentation integrity and refusal to chart unperformed examinations
- Informed consent, confidentiality and HIPAA
- PA scope of practice and the supervising physician relationship
- Study design and interpretation of p values, odds ratios and relative risk
- Risk management and professional liability
- Public health reporting obligations
- Cultural competence and communication with patients
Recommended Study Plan
- 1Download the PANCE content blueprint PDF from nccpa.net and write out the 14 organ system weights, the 6 percent Professional Practice allocation and the eight task weights on one page you keep visible.
- 2Read NCCPA's Sample PANCE Questions PDF and the critiques attached to each item, paying attention to how the critique reasons about the wrong options.
- 3Sit a full-length practice exam such as the NCCPA Practice Exam or a Rosh Review qualifying exam, timed, in one sitting, to establish a baseline scaled score.
- 4Apply for PANCE through the NCCPA portal once your program has confirmed your completion date, and note the 180-day window in your acknowledgement email.
- 5Rank the 14 organ systems by your baseline subscore and multiply each gap by its blueprint weight to decide where hours actually pay.
- 1Work the full cardiovascular section of Rosh Review or UWorld PA, roughly 150 questions, and read every explanation.
- 2Build electrocardiography pattern recognition to the level of the vignette: rate, rhythm, axis, ischaemic change, chamber enlargement.
- 3Study heart failure, acute coronary syndromes, valvular disease, arrhythmias, hypertension and peripheral vascular disease from PANCE Prep Pearls.
- 4Drill the diagnostic study choices specific to cardiology, since Using Diagnostic and Laboratory Studies items concentrate here.
- 5Write a one-page cardiology drug sheet covering beta blockers, ACE inhibitors, anticoagulants, antiarrhythmics and statins.
- 1Complete pulmonary and infectious disease question blocks in your question bank and log every miss by cause.
- 2Study obstructive and restrictive disease, pneumonia, pulmonary embolism, pleural disease and tuberculosis.
- 3Learn empiric antimicrobial selection for the common syndromes, which sits at the intersection of Infectious Diseases and Pharmaceutical Therapeutics.
- 4Review paediatric infectious presentations, since NCCPA states 12 to 15 percent of the exam concerns paediatric conditions.
- 5Practise 60 mixed questions in one timed block to rehearse the exam's block structure.
- 1Work gastrointestinal and musculoskeletal question blocks in full.
- 2Study the physical examination manoeuvres for the shoulder, knee, hip and spine by name, including McMurray, Lachman, Phalen and Finkelstein.
- 3Review upper and lower gastrointestinal bleeding, inflammatory bowel disease, hepatobiliary disease and nutritional deficiencies.
- 4Cover fracture patterns and the orthopaedic emergencies that require immediate intervention.
- 5Do a general surgery topic sweep, since NCCPA states surgical topics reach up to 8 to 10 percent of the exam.
- 1Complete neurology and psychiatry question blocks.
- 2Study stroke syndromes, seizure classification, headache differentiation, neuropathy and neurodegenerative disease.
- 3Learn DSM-based diagnostic criteria for the mood, anxiety, psychotic and neurocognitive disorders, and practise distinguishing delirium from dementia in a vignette.
- 4Review psychotropic drug classes, their adverse effects and their monitoring requirements.
- 5Sit a timed 60-question mixed block and compare pacing against the 60-minute limit.
- 1Work reproductive, endocrine and EENT question blocks.
- 2Study obstetric emergencies including abruptio placentae, placenta previa and vasa previa, which NCCPA's own sample question set touches directly.
- 3Cover thyroid, adrenal, pituitary, parathyroid and diabetes topics, including the laboratory patterns that separate them.
- 4Review common ophthalmologic and otolaryngologic presentations and their red flags.
- 5Rebuild your subcategory scoreboard and compare it against the week 1 baseline.
- 1Work renal, genitourinary, hematologic and dermatologic question blocks.
- 2Master acid-base and electrolyte interpretation, which recurs across renal, endocrine and pulmonary items.
- 3Study anaemia classification by mean corpuscular volume, coagulation disorders and the common malignancies.
- 4Build a dermatology image bank and practise identifying lesions from written description alone, since PANCE items describe rashes in prose.
- 5Review acute kidney injury, chronic kidney disease staging and nephrolithiasis management.
- 1Work through Professional Practice content: disclosure of error, informed consent, documentation integrity, scope of practice and HIPAA.
- 2Learn to interpret p values, odds ratios, relative risk, sensitivity, specificity and predictive values well enough to answer a study-design item cold.
- 3Reread NCCPA's sample Professional Practice questions and their critiques, which model the ethical reasoning the exam rewards.
- 4Filter your question bank by task category and drill the two task areas where you score lowest.
- 5Sit a second full-length practice exam and compare the scaled score to your baseline.
- 1Give the three organ systems with the widest gap between blueprint weight and your subscore the whole of the week's question volume.
- 2Redo every question you have ever missed and confirm you can articulate why each distractor is wrong.
- 3Complete two 300-question simulations across separate days, in five timed 60-question blocks each, taking only the 45 minutes of break time the real exam allows.
- 4Rebuild your one-page drug sheets for the classes you keep missing.
- 5Confirm your Pearson VUE appointment sits inside the 180-day window from your acknowledgement email.
- 1Cut to 60 to 100 questions a day and stop introducing new material.
- 2Review your one-page blueprint sheet, drug sheets and laboratory pattern sheets each morning.
- 3Check the identification you plan to bring against NCCPA and Pearson VUE's published requirements, and bring the number of forms they specify.
- 4Plan the six-hour appointment: what you will eat, when you will take each of the four breaks, and how you will split the 45 minutes.
- 5Stop studying the day before and sleep. The exam is five hours of testing across a six-hour appointment.
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Best Study Resources
PANCE Content Blueprint, effective January 2025
Official blueprint PDFNCCPA's own specification: 14 organ systems plus Professional Practice with percent allocations, eight weighted task categories, and the detailed disease and disorder listings under each organ system. It also states the surgical and paediatric coverage figures.
Free
Sample PANCE Questions with critiques
Official practice itemsItems retired from the item pool and released by NCCPA, each tagged with its medical content category and accompanied by a critique from test committee members explaining why the key is correct and why every distractor is wrong.
Free
NCCPA PANCE Practice Exams
Official practice examPractice exams sold by NCCPA itself. NCCPA states explicitly that these are not intended to predict PANCE performance and should not be interpreted as a prediction, but that results may help identify strengths and weaknesses across blueprint content areas.
Paid, purchased through the NCCPA portal
PANCE Performance Guide
Official scoring explainerNCCPA's explanation of the 200 to 800 scale, the 350 cut score, the modified Angoff standard setting method, the first-time-taker reference group, and how to read subscores and their standard error bars.
Free
Rosh Review PANCE Qbank
Question bankA large question bank with explanations and rapid-review cards, filterable by both blueprint organ system and task category, which is what makes the task-dimension drilling in week 8 possible.
Paid subscription, tiers set by Rosh Review
PANCE Prep Pearls
Review textbookA condensed content review organised by organ system, which is the dimension the blueprint weights. It suits candidates who want compressed text rather than a full medical reference.
Paid, price set by the author
UWorld PA QBank
Question bankVignette-style questions with illustrated explanations, mapped to the NCCPA blueprint. Its self-assessment exams produce a scaled estimate that lets you track movement across the 200 to 800 range.
Paid subscription, tiers set by UWorld
SMARTY PANCE interactive blueprint
Free blueprint navigator and paid courseBreaks the NCCPA blueprint into its organ system sections and subsections with linked study notes, which makes it straightforward to confirm you have touched every listed disease rather than only the memorable ones.
Free blueprint navigation, paid course tiers
Five Year Pass Rates for PANCE
Official statistics PDFNCCPA's published table of candidate volumes, pass rates, mean scores and standard deviations for all takers and first-time takers over the last five years. Updated in the first quarter of each year and the correct citation for any pass rate claim.
Free
NCCPA Exam Development and Scoring page
Official policy pageExplains how items are written and reviewed, how pretest items are seeded and calibrated, how the passing standard is set, and the scale range and passing standard for PANCE, PANRE and PANRE-LA side by side.
Free
Common Mistakes to Avoid
Studying organ systems in the order a textbook presents them rather than in the order the blueprint weights them.
Cardiovascular is 11 percent and Pulmonary is 9 percent, while Dermatologic and Genitourinary are 4 percent each. Multiply your practice subscore gap in each system by that system's weight and spend hours in that order. A perfect dermatology score buys you at most 12 questions out of 300.
Answering with the most definitive test rather than the most appropriate initial test.
NCCPA's own sample critique makes this explicit: coronary arteriography is the most definitive test for coronary artery disease but is wrong as an initial step in an asymptomatic patient with a normal electrocardiogram, where the exercise stress test wins on being noninvasive, inexpensive and sensitive. Read whether the stem asks for initial, most appropriate, or most definitive.
Ignoring the task dimension of the blueprint entirely and preparing only by organ system.
Formulating Most Likely Diagnosis is 18 percent, History Taking and Physical Examination is 16 percent, and Clinical Intervention is another 16 percent. Filter your question bank by task category and find out whether you are losing points on diagnosis, on management, or on test selection, because the remedy differs for each.
Treating Professional Practice as unstudiable common sense and skipping it.
It is 6 percent, roughly 18 questions, and it is the only category coded outside the task dimension. NCCPA's released items cover disclosing an embryo implantation error immediately, refusing to chart a McMurray test that was not performed, and identifying the p value as the marker of statistical significance. All three are learnable rules, not intuitions.
Mismanaging the 45 minutes of break time, either burning it early or never using it.
NCCPA states candidates are responsible for managing their own break time, and that any scheduled break time used beyond the 45 minutes is deducted from exam time and may close the exam earlier than expected. Decide in advance how to split 45 minutes across four inter-block gaps, and rehearse that split during your full-length simulations rather than improvising on the day.
Assuming a raw percentage correct translates into a scaled score, and chasing a target like 70 percent.
NCCPA states that because forms are equated for difficulty, the number of correct answers required to meet the passing standard varies from one examinee to another. Track your scaled or predicted score from practice exams instead, and read the 350 cut against the 200 to 800 range rather than against a percentage.
Overreading a weak subscore on a small content area after a practice exam or a real score report.
NCCPA warns that subscores should be interpreted with caution because smaller content areas such as Hematology carry fewer questions and therefore wider standard error bars. A poor hematology subscore may reflect five unlucky items. Look at the width of the error bar before rebuilding a study plan around one number.
Scheduling the exam without accounting for the 180-day window or the 90-day retake interval.
Your acknowledgement email defines a 180-day testing window based on your graduation date and your application. You may take PANCE only once in any 90-day period and no more than three times in a calendar year. Booking too late in the window leaves no room to retake within the same calendar year if the first attempt fails.
Neglecting paediatric and surgical content because neither is a named organ system on the blueprint.
NCCPA states that 12 to 15 percent of questions focus on conditions in paediatric patients and up to 8 to 10 percent cover general surgical topics, spread across the organ systems rather than gathered in one place. Deliberately filter your question bank for paediatric and surgical presentations within each system block.
Exam Day Tips
- 1
Plan for a six-hour appointment, not a five-hour one. Five blocks of 60 minutes plus 45 minutes of break time plus a 15-minute tutorial is what the schedule actually consumes.
- 2
Bring two forms of valid and current identification. NCCPA's Test Day page requires one ID carrying a permanently affixed photo with your printed name and signature, and a second carrying your printed name and signature. You will not be admitted if the names on your ID do not match the name NCCPA holds for you.
- 3
Use the 15-minute tutorial deliberately rather than clicking through it. It runs before the first block and does not consume block time, so it is free acclimatisation to the interface.
- 4
Decide your break split before you arrive. With 45 minutes across four gaps, roughly 10 to 12 minutes each is even, but many candidates prefer a longer break after block three when concentration drops.
- 5
Eat and hydrate on a scheduled break, when NCCPA permits access to your locker. On an unscheduled break you may access nothing beyond medication or food required at a specific time with NCCPA's prior approval, and the time comes out of your question clock.
- 6
Pace at one minute per question inside each block. Sixty questions in 60 minutes leaves no slack, so flag and move rather than stalling on a single vignette.
- 7
Leave watches of any kind in the locker. NCCPA's prohibited list covers brimmed hats, bags, books, notes, calculators, watches of any kind, phones, outerwear and food or drink, and a locker is assigned for them. Within a block you may answer questions in any order and change answers freely, but once you exit the block that is closed to you.
- 8
Do not try to identify pretest items. NCCPA states examinees have no way of distinguishing scored from pretest items, so treating a strange question as unscored is a guess that costs attention.
- 9
Expect no score at the centre. NCCPA releases results typically within about two weeks of the exam, through your NCCPA portal account.
Career Paths & Salary Ranges
Physician assistant, primary care
Family medicine and internal medicine practices are the most common first destination for a newly certified PA, and the work maps almost directly onto the blueprint's Health Maintenance and Preventive Measures category plus the broad organ system coverage.
$129,640 median, offices of physicians (BLS, May 2024)
Physician assistant, emergency medicine
Emergency departments reward the Clinical Intervention and Formulating Most Likely Diagnosis skills that together make up 34 percent of the exam. BLS puts the May 2024 hospital median for PAs at $136,630 against $129,640 in offices of physicians.
$136,630 median, hospitals (BLS, May 2024)
Physician assistant, surgical subspecialty
Orthopaedic, cardiothoracic and general surgery practices employ PAs for first assisting, preoperative workup and postoperative management. The surgical content NCCPA places at up to 8 to 10 percent of PANCE is the entry point, with the rest learned on the job.
$136,630 median, hospitals (BLS, May 2024)
Physician assistant, hospital medicine
Inpatient PAs admit, round and discharge alongside hospitalists. Admission and discharge criteria, the exact reasoning NCCPA tests in its Clinical Intervention items, become the daily decision.
$136,630 median, hospitals (BLS, May 2024)
Physician assistant with a Certificate of Added Qualifications
NCCPA offers specialty CAQs to Board Certified PAs who log 75 Category 1 CME credits focused on the specialty within the six years before applying, with at least 25 earned in the two years before application, plus specialty-specific experience requirements and a specialty exam.
$133,260 national median, $182,200 at the 90th percentile (BLS, May 2024)
Prerequisites & Requirements
- Graduate from an entry-level PA program accredited by the Accreditation Review Commission on Education for the Physician Assistant (ARC-PA). NCCPA deems a graduate to have graduated from an accredited program if the program was accredited at the time of matriculation.
- Have your PA program notify NCCPA of your expected graduation date, which triggers the email you use to set up your NCCPA portal account. That setup link expires after three days.
- Submit the PANCE application with the $550 payment. NCCPA does not accept applications until 180 days before your expected program completion date.
- Wait until at least seven days after your program completion date, which is the earliest date you may test once your program director has confirmed completion.
- Test within the 180-day window shown in your acknowledgement email, which arrives within three days of a submitted application.
- Observe the eligibility limits: six years from completing graduation requirements and six attempts, whichever runs out first, for anyone who graduated on or after January 1, 2003 and has never been certified.
- There is no work experience requirement, no separate licence prerequisite and no minimum GPA imposed by NCCPA. Program accreditation and completion are the whole of the eligibility test.
Frequently Asked Questions
How much does the PANCE cost?
The PANCE application fee is $550, paid to NCCPA when you apply through the NCCPA portal. There is no additional fee to Pearson VUE at the test centre. The fee covers one attempt and the 180-day scheduling window that follows. Each subsequent attempt requires a new application and a new $550 payment. For comparison, the recertification exams cost $350 whether a PA chooses PANRE or PANRE-LA, and the certification maintenance fee logged with 100 CME credits every two years is $180.
What is the passing score for PANCE?
350, on a scale that runs from 200 to 800. NCCPA sets the standard through the modified Angoff method, in which a panel of practising Certified PAs judges each question against whether a just-qualified candidate would answer it correctly, and the aggregated recommendation goes to the NCCPA Board of Directors for approval. Because every form is equated for difficulty through automated test assembly, NCCPA states the number of correct answers needed to reach 350 differs from examinee to examinee. There is no percentage-correct target that guarantees a pass.
What happens if I fail the PANCE?
You may retake it, subject to three limits that run simultaneously. You may take PANCE only once in any 90-day period, no more than three times in a calendar year, and no more than six times in total. Eligibility also expires six years after you complete graduation requirements, and whichever of the six years or six attempts runs out first ends your eligibility. NCCPA states the only way to establish new eligibility after that is to complete an unabridged ARC-PA accredited PA educational program again. Each retake needs a new application and a new $550 fee.
How long do PANCE results take?
Typically about two weeks from the test date. Results appear in your NCCPA portal account, and no score is given at the Pearson VUE centre. The score report shows your scaled score against the 350 passing score and gives content area subscores with standard error bars. NCCPA notes that larger content areas such as Cardiovascular carry more questions and therefore narrower error bars, while smaller areas such as Hematology have wider ones.
How does the PANCE reference group work?
The PANCE reference group comprises first-time takers, specifically every examinee over the past two years who sat PANCE for the first time ever. NCCPA uses a two-year span so the sample is large enough to cover test takers at all ability levels. Your score report positions you against that group. This means a comparison against repeat takers is not what the report shows, and it also means the reference population shifts slightly each year.
How many questions on the PANCE are unscored?
NCCPA does not publish the number. It states that its proctored exams, PANCE and PANRE, include both scored and pretest items, and that examinees have no way of distinguishing between the two types. Pretest items exist so NCCPA can collect performance statistics before deciding whether a question meets the standard for use as a scored item on future exams. Practically, treat every one of the 300 questions as scored.
What identification do I need for PANCE?
Two forms of valid and current ID. NCCPA's Test Day page states that one must carry a permanently affixed photo with your printed name and signature, and the second must carry your printed name and signature. You will not be admitted if the names on your ID do not match the name listed with NCCPA, which is why NCCPA asks to be notified immediately when a name needs changing in its records. A photo, signature, fingerprint and/or palm vein image is captured before admission, and the fingerprint or palm vein scan is repeated every time you re-enter the exam room.
Can I take the PANCE online with remote proctoring?
No. PANCE is administered only in person at Pearson VUE test centres, of which NCCPA says there are more than 300 offering the exam year round. The recertification alternative PANRE-LA is delivered online on the PA's own device across quarterly question sets, and PANRE itself is delivered at Pearson VUE centres. Only the longitudinal recertification assessment escapes the test centre, and it is not available to anyone seeking initial certification.
Are reference materials or a calculator allowed during PANCE?
No outside references are permitted in a Pearson VUE test centre for PANCE. The contrast with PANRE-LA is instructive: NCCPA explicitly permits PANRE-LA participants to use printed or online references while answering, because that assessment is delivered on the PA's own device, but forbids consulting other people. That permission is specific to PANRE-LA and does not extend to the proctored PANCE administration.
Are testing accommodations available for PANCE?
Yes. NCCPA requires the Testing Accommodations Request Form, available during the exam application process, to be completed and submitted for every examination application. Approval is not automatic and prior approval of an accommodation does not guarantee approval for a later exam. Depending on how long ago earlier documentation was submitted, the date of that documentation, and any change in the nature or extent of the disability, NCCPA may require additional documentation.
How long is NCCPA certification valid and what does maintaining it require?
Certification runs on a 10-year maintenance cycle made up of five two-year cycles. In each two-year cycle a Board Certified PA must earn and log 100 CME credits, of which at least 50 must be Category 1, and submit the $180 certification maintenance fee by 11:59 p.m. Pacific on December 31 of the certification expiration year. By the end of the 10th year, the PA must also pass either PANRE or PANRE-LA. NCCPA awards 50 percent additional credit for self-assessment Category 1 activities and doubles the first 20 PI-CME credits logged in each cycle.
How does PANCE compare with PANRE?
PANRE is the recertification exam, shorter and with a higher cut score. PANCE is 300 questions in five 60-minute blocks with a passing score of 350 on the 200 to 800 scale. PANRE is four blocks of 60 questions, four hours of testing inside a five-hour schedule, with a passing score of 379 on the same scale. Both use the same 45 minutes of break time and 15-minute tutorial structure and both run at Pearson VUE centres. PANRE is available in the 9th or 10th year of the maintenance cycle, up to two attempts in year nine and three in year ten, capped at four total.
What is PANRE-LA and why would a PA choose it over PANRE?
PANRE-LA is the longitudinal alternative to the proctored recertification exam, taken online across 12 quarters in years seven through nine of the maintenance cycle. Each quarter delivers 25 questions with five minutes allowed per question, and feedback including the correct answer, an explanation and references appears immediately. The scale runs 1000 to 1500 with a passing standard of 1150, and the final score uses the best eight quarters. Answering all 25 questions in a quarter earns two Category 1 self-assessment CME credits, or three after NCCPA's 50 percent self-assessment bonus. The fee is $350, the same as PANRE.
How many organ systems does the PANCE blueprint cover and what are the weights?
Fourteen organ systems plus Professional Practice. The medical content weights effective January 2025 are Cardiovascular 11 percent, Pulmonary 9 percent, Gastrointestinal System and Nutrition 8 percent, Musculoskeletal 8 percent, Infectious Diseases 7 percent, Neurologic 7 percent, Psychiatry and Behavioral Science 7 percent, Reproductive 7 percent, Endocrine 6 percent, Eyes Ears Nose and Throat 6 percent, Hematologic 5 percent, Renal 5 percent, Dermatologic 4 percent, Genitourinary 4 percent, and Professional Practice 6 percent. Medical content is 94 percent of the exam and every medical content question is also coded to a task area, except Professional Practice items.
When can I apply for the PANCE and how soon can I test?
NCCPA does not accept applications until 180 days before your expected program completion date, as provided by your program director. The earliest you can test is seven days after your program completion date, once the program director confirms it, and that date appears in your acknowledgement email. You receive the acknowledgement within three days of submitting the application, and it defines a 180-day window inside which you schedule with Pearson VUE, subject to test centre availability.
Does passing PANCE license me to practise?
No. Passing PANCE gives you NCCPA board certification and the right to use the PA-C and Physician Assistant-Certified marks while you maintain that certification. A state licence is separate and is issued by the state medical or PA board, which sets its own application, background check and fee requirements. NCCPA notes that all 50 states, the District of Columbia, the U.S. territories, the U.S. military and many employers rely on NCCPA certification as one of the criteria for employment, licensure or regulation, but the licence itself comes from the state.
How much of the exam is paediatric or surgical?
NCCPA specifies both figures in the blueprint. Up to 8 to 10 percent of the exam covers general surgical topics, and 12 to 15 percent of questions focus on conditions in paediatric patients. Neither is a separate content category, so both are distributed across the 14 organ systems. NCCPA also cautions that the specific percentage allocations may vary slightly from one exam form to another.
Do PANCE subscores tell me what to study after a failed attempt?
Partly, and NCCPA tells you to read them carefully. Subscores are estimated using augmented scoring, a statistical method that considers relationships between content areas to supplement the raw performance in each. Even with that augmentation, NCCPA states subscores should be interpreted with caution, because a different set of questions in the smaller blueprint areas could produce a different subscore interpretation. Weight your remediation toward large content areas with weak subscores, where the error bar is narrow enough to trust.
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