Overview
The Physician Assistant National Certifying Examination (PANCE) is the exam run by the National Commission on Certification of Physician Assistants (NCCPA) for new physician assistant (PA) graduates in the United States. It tests clinical knowledge, clinical reasoning and professional behaviours.
Who can apply
Graduates of entry-level PA programmes accredited by ARC-PA are eligible. Your programme tells NCCPA your graduation date, and NCCPA then emails you to set up an online account.
A "six years, six attempts" rule applies: you may sit the exam up to six times within six years of graduating from your PA programme.
Exam pattern
| Feature | Detail |
|---|---|
| Blocks | 5 |
| Questions per block | 60 |
| Total questions | 300 |
| Time per block | 60 minutes |
| Total testing time | 6 hours, including a 15 minute tutorial and 45 minutes of breaks between blocks |
Syllabus
The content blueprint has two dimensions: the organ system a question concerns and the clinical task it tests. Professional practice makes up 6% of the exam, and the organ systems below make up the other 94%.
Organ systems
| System | Share of exam |
|---|---|
| Cardiovascular | 11% |
| Pulmonary | 9% |
| Gastrointestinal and nutrition | 8% |
| Musculoskeletal | 8% |
| Infectious diseases | 7% |
| Neurologic | 7% |
| Psychiatry and behavioural science | 7% |
| Reproductive | 7% |
| Endocrine | 6% |
| Eyes, ears, nose and throat | 6% |
| Hematologic | 5% |
| Renal | 5% |
| Dermatologic | 4% |
| Genitourinary | 4% |
Task areas
| Task | Share of exam |
|---|---|
| Formulating the diagnosis | 18% |
| History taking and physical examination | 16% |
| Clinical intervention | 16% |
| Pharmaceutical therapeutics | 15% |
| Health maintenance and prevention | 11% |
| Diagnostic and laboratory studies | 10% |
| Basic scientific concepts | 8% |
The blueprint also notes that roughly 8 to 10% of content involves surgical topics and 12 to 15% involves paediatric cases, with slight variation between administrations.
Important dates
You can apply up to 180 days before your expected programme completion date. The testing window opens seven days after programme completion and runs for 180 days. You may test only once in any 90-day period and no more than three times a year.
Fees
NCCPA lists the application and examination fee as $550, as shown on the official site in 2026.
How to apply
Once your programme has reported your graduation date and you have created your NCCPA account, submit the online application with payment.
Preparation tips
Use the published blueprint to weight your revision, giving most time to cardiovascular, pulmonary, gastrointestinal and musculoskeletal content.
Practise sitting five 60 minute blocks in a row so the full length feels familiar.
Keep the attempt limits in mind and plan your first attempt carefully.
How many questions are on the PANCE?
There are 300 questions, split into five blocks of 60, with 60 minutes allowed for each block.
How many times can I take the PANCE?
Up to six attempts within six years of graduating, and no more than three attempts a year or one in any 90-day period.
How much does the PANCE cost?
NCCPA lists the fee as $550 in 2026.