The Physician Assistant National Certifying Exam (PANCE®) is the certification exam required to practice as a physician assistant (PA) in the United States. Administered by the National Commission on Certification of Physician Assistants (NCCPA), the PANCE® tests your medical and surgical knowledge across the full spectrum of clinical medicine. You must pass the PANCE® after graduating from an accredited PA program to become a certified PA-C and practice clinically. This page covers the exam format, content blueprint, scoring, preparation strategies, and recommended resources.
Exam Format and Structure
The PANCE® is a computer-based exam consisting of 300 multiple-choice questions divided into five 60-question blocks, each with a 60-minute time limit. Total testing time is approximately 5 hours, plus breaks between blocks. The exam is offered year-round at Pearson VUE testing centers.
Questions are organized around two dimensions: organ systems and the tasks you perform as a PA. The organ system categories include cardiovascular, pulmonary, gastrointestinal and nutritional, musculoskeletal, eyes/ears/nose/throat, reproductive, endocrine, neurologic, psychiatric and behavioral, dermatologic, hematologic, infectious disease, renal and urinary, and genitourinary. The task categories include history taking and physical examination, diagnostic studies, formulating the most likely diagnosis, clinical intervention (pharmacologic and nonpharmacologic), health maintenance and disease prevention, and clinical therapeutics.
The NCCPA publishes a detailed Content Blueprint that specifies the percentage of questions from each organ system and task area. Cardiovascular, pulmonary, and gastrointestinal and nutritional systems typically represent the largest portions of the exam, followed by musculoskeletal and endocrine systems. Review the current blueprint on the NCCPA website to guide your study plan allocation.
Registration and Eligibility
You are eligible to take the PANCE® after graduating from an ARC-PA accredited PA program. Registration is managed through the NCCPA website. The exam fee is approximately $550. You can take the PANCE® up to six times within six years of completing your PA program. If you do not pass within this window, you must complete additional education before reattempting. Most graduates take the exam within 90 days of graduation to capitalize on the clinical knowledge from their rotations.
Scoring
The PANCE® uses a scaled scoring system with a score range of 200 to 800. The minimum passing score is 350. Results include your total scaled score and performance profiles for each content area and task area, allowing you to identify specific strengths and weaknesses if a retake becomes necessary. Scores are released approximately 2 to 3 weeks after the exam date. The first-time pass rate for PANCE® is typically between 90 and 95 percent, though this varies by program and by graduating class.
How to Prepare
Most PA graduates study for 4 to 8 weeks before taking the PANCE®. Your clinical rotation year is the foundation of your preparation; the patients you see and the clinical decisions you participate in during rotations form the knowledge base the exam tests. Your dedicated study period should focus on organizing, reviewing, and reinforcing this clinical knowledge through structured question practice and targeted content review.
We recommend scheduling your exam within 60 to 90 days of graduation. Delaying beyond this window allows clinical knowledge from your rotations to fade and demonstrably decreases first-time pass rates. Begin your study plan during the last rotation of your PA program if possible, so you can hit the ground running after graduation.
Recommended Study Resources (Free First)
NCCPA Practice Exam (Paid, Official): The NCCPA offers an official practice exam that uses retired PANCE® questions. This is the most accurate benchmark for your readiness and should be taken at least once during your preparation period.
NCCPA Content Blueprint (Free): Download the current PANCE® Content Blueprint from the NCCPA website. Use it to allocate your study time proportionally across organ systems and task areas. If cardiovascular content makes up 16 percent of the exam, for example, it should receive proportional attention in your study plan.
Khan Academy® (Free): Khan Academy® covers many of the clinical and basic science topics tested on the PANCE®, including pathophysiology, pharmacology, and anatomy. Useful for targeted content review. See our Khan Academy® guide.
Your PA Program’s Materials (Free): Your lecture notes, end-of-rotation exam reviews, and any PANCE® review materials provided by your program are among the most relevant resources you have. Review them systematically during your study period.
Anki Flashcard Decks (Free): Community-created PANCE® Anki decks cover high-yield clinical facts organized by organ system. Use spaced repetition daily during your study period. See our spaced repetition guide.
Question Banks and Review Courses (Paid): Several companies offer PANCE®-specific question banks and comprehensive review courses. These are popular among PA graduates and can be effective when used alongside official resources. We do not recommend specific products and do not place affiliate links. Ask recent graduates from your program which resources they found most helpful.
Study Strategies
Question-Driven Review: Practice questions should be the core of your preparation. Complete at least one full pass through a question bank, reviewing explanations for every question. Focus on understanding the clinical reasoning behind each answer, not just memorizing the correct choice. When you miss a question, write down the key concept you missed and add it to your review list. Revisit these missed concepts at regular intervals throughout your study period to ensure long-term retention.
Proportional Study Time: Allocate your study hours based on the Content Blueprint. Spend more time on high-weight organ systems (cardiovascular, pulmonary, GI) and less on lower-weight systems. Within each system, prioritize common conditions over rare diseases.
Clinical Integration: Connect what you are studying to the patients you saw during rotations. When reviewing a condition, recall specific patients with that diagnosis and the clinical decisions your preceptor made. This active recall strengthens both your memory and your clinical reasoning.
Test Day and After the Exam
Arrive at the testing center early with valid government-issued photo ID. The exam consists of five blocks with scheduled breaks. Pace yourself carefully within each block; you have 60 minutes for 60 questions, which gives you about one minute per question. If you are unsure about a question, make your best choice and move forward. You can flag questions to review within a block, but you cannot return to previous blocks.
Scores are released approximately 2 to 3 weeks after the exam. If you pass, you can proceed with your state’s certification process to obtain your PA-C designation. If you do not pass on your first attempt, review your performance profile to identify the content areas and task areas where you scored below the passing standard, adjust your study plan accordingly, and schedule a retake. The NCCPA allows up to six attempts within six years of graduation. Most students who retake the exam improve their scores significantly when they focus their preparation on their weakest areas.
For career context, see our physician assistant career profile. For application guidance, see our CASPA® application guide. For comparisons, see our PA vs. NP comparison and physician vs. PA vs. NP comparison.
References
National Commission on Certification of Physician Assistants (NCCPA). “PANCE.” NCCPA, 2025. https://www.nccpa.net/pance/. Accessed March 2026.
National Commission on Certification of Physician Assistants (NCCPA). “PANCE Content Blueprint.” NCCPA, 2025. https://www.nccpa.net/pance-content-blueprint/. Accessed March 2026.
Khan Academy. “Health and Medicine.” Khan Academy, 2025. https://www.khanacademy.org/science/health-and-medicine. Accessed March 2026.