The Physician Assistant National Certifying Examination (PANCE) was developed by the National Board of Medical Examiners (NBME) with funding from the U.S. Department of Health, Education, and Welfare and the Kellogg Foundation. When it was first given in 1973, examination content was based on an analysis of the actual work performed by physician’s assistants (PA’s) using results of a large survey of PA’s and their supervising physicians. At that time, any graduate of an American Medical Assocation (AMA) approved PA program could sit for the exam. In addition, contracts with funding agencies required that “informally trained” PA’s working in the field also be allowed to sit for the exam.
By 1974, the newly formed, independent nonprofit National Commission on Certification of Physician Assistants (NCCPA) assumed oversight responsibility for the PANCE. This includes determining who is eligible to take the exam, creating a content “blueprint” based on periodic practice analyses, setting passing standards, issuing certificates to those who successfully pass the PANCE, and establishing mechanisms for maintaining current certification. The NCCPA includes representatives from a number of medical organizations and insures that PA’s play an active role in setting professional standards.
The NCCPA made a number of changes to the original examination. They reorganized the content into three assessment areas, including a Clinical Skills Portion (CSP) which required candidates to perform actual physical examinations based on clinical case studies they were given. When the NCCPA began converting the PANCE to a computer-based exam in 1997, they streamlined the multiple choice portion of the exam, offering a core component and an optional extended core component in surgery. The CSP was also dropped at this time because it didn’t fit into the computerized delivery model.
The NCCPA also changed the eligibility criteria in 1987 so that “informally trained” PA’s were no longer allowed to sit for the PANCE, based on the high failure rates of those who had not been prepared through an approved PA program.
To insure that PA’s in the field continued to develop the knowledge and skills to keep abreast with current patient needs, by 1981 the NCCPA began requiring PA’s to retake the PANCE every 6 years to recertify. In 1984, they began administering a separate recertification exam, the PANRE (Physician Assistant National Recertification Examination) to meet this requirement. Recently, the recertification testing requirement has been changed to every 10 years.
Function of the Test
The PANCE and PANRE are national examinations that were established to insure that PA’s meet standard criteria for knowledge and clinical competence before entering into and being allowed to continue to practice their profession. After graduating from an accredited PA program, you must pass the PANCE to be PA-C certified by the NCCPA. NCCPA certification is required in all 50 states, the District of Columbia, and US territories in order to obtain authorization to practice (licensure or registration). PA-C certification is kept current by completing a certain number of continuing medical education (CME) credits and paying a $130 CME fee every two years, and taking and passing the PANRE every 10 years. While not all states require recertification in order to maintain licensure, several states require it in orer to maintain prescribing authority. 
Today, nearly 100,000 PA’s are licensed in the United States. All are graduates of an accredited PA program, and two-thirds have a Master’s Degree or higher. While PA’s practice in all 50 states and abroad, the greatest concentration is in the Northeast and Northwest, and a few central states. Over 25% of PA’s practice in a primary care setting and another 23% are in a surgical or emergency care specialty. Demand for PA’s is growing; according to a recent NCCPA survey, 78.1% of recent PA program graduates had multiple job offers from which to choose. As the profession grows, additional career options are opening up in health care policy and administration and in higher education. .
In 2013, 7,504 people took the PANCE, most for the first time. Overall, 94.3% passed the exam the first time they took it. 
In order to take the PANCE, you must have been graduated from a PA program accredited by the Accreditation Review Commission on Education for the Physician Assistant (ARC-PA). Certain exceptions apply to those who completed their education prior to 1994. You have up to 6 years after graduation to sit for the exam, and you may take it up to six times within that period in order to achieve a passing score. 
You may apply to the NCCPA for authorization to take the PANCE no sooner than 90 days before you expect to complete your PA programs graduation requirements. Once your application materials and pre-paid $475 application fee are processed, the NCCPA will send you an acknowledgement letter via e-mail, along with instructions for scheduling your exam. You will be given a window beginning 7 days after your expected PA program completion date, and extending out 180 days in which to take the PANCE.
If you do not pass your test, you can take it again as many as 6 times, but no more frequently than 3 times per year. You must wait at least 90 days between attempts. You will have a total of 6 years in which to pass the PANCE; if you fail on your 6th attempt, you will need to enter and successfully complete a new ARC-PA-approved program before you will be eligible to sit for the exam again. 
Once you have met your CME requirements, you may apply to take the PANRE any time within two years prior to the end of your current 10-year certification cycle by submitting an online application and $350 testing fee to the NCCPA. You will be given up to a 180-day window in which to take the exam based upon where you are in your certification cycle. If you do not pass your test, you may take it again once every 90 days, up to 3 attempts per calendar year. You must pass the exam before the end of your current cycle in order to maintain your PA-C certification.
Once your existing certification has expired, you are no longer eligible to take the PANRE and must instead apply for and re-take the PANCE in order to re-establish your PA-C status. You do not have to complete CMEs in order to re-take the PANCE. 
Scheduling and Taking the Test
PA certification testing is conducted at authorized Pearson VUE testing centers across the country. Application materials and fees are processed through the NCCPA. Once you are approved for testing, you may schedule your test online or by phone directly with Pearson VUE.
The NCCPA and Pearson VUE testing centers are ADA-compliant and offer special accommodations to candidates with medical disabilities covered under the ADA, as well as certain other medical conditions that may not be covered due to their temporary or special nature. Accommodations include but are not limited to providing additional testing time, allowing more frequent breaks between blocks of questions, providing separate testing rooms, and permitting use of certain medical devices and text readers. Special accommodations must be requested in writing and approved by the NCCPA. Forms are available at the NCCPA Web site. 
|Sections of the PANRE/PANCE Test|
|PANRE/PANCE Test Subject Areas||% of Exam|
|History Taking and Performing Physical Examinations||16%|
|Using Laboratory and diagnostic Studies||14%|
|Formulating Most Likely Diagnosis||18%|
|Applying Basic Science Concepts||10%|
On the day of the exam, each candidate is expected to arrive at least half an hour early to ensure enough time to be admitted into the testing center and get settled in. For admission, two forms of ID are required, one of which must be a photo ID that contains a name and signature. Personal items such as hats, books, bags, study materials, electronics, and snacks are not allowed in the testing center. A locker will be provided to store restricted items for the duration of the exam. The PANCE subtest, break, and tutorial combined lasts around six hours. The PANRE takes around five hours.
The Physician Assistant National Certifying Exam (PANCE) and the Physician Assistant National Recertifying Exam (PANRE) serve to certify and recertify physician assistants respectively. Both the PANRE and the PANCE have to do with seven major Knowledge and Skill Areas: History Taking and Performing Physical Examinations; Using Laboratory and Diagnostic Studies; Formulating Most Likely Diagnosis; Health Maintenance; Clinical Intervention; Pharmaceutical Therapeutics; and Applying Basic Science Concepts. The PANCE contains 300 multiple choice questions, and the PANRE contains 240 multiple choice questions.
- PANCE Sample Questions
- Which of the following medications would you NOT use in a patient with restrictive cardiomyopathy?
- A. Furosemide
- B. Metoprolol
- C. Aspirin
- D. Epinephrine
- Which of the following is a major contributing factor to the development of osteoarthritis?
- A. Immune disorder
- B. Degenerative disease
- C. Congenital disorder
- D. Infectious etiology
- You are seeing a patient who has a B-type natriuretic peptide (BNP) level of 680. What condition is this elevated lab usually associated with?
- A. Lung cancer
- B. Congestive heart failure
- C. Pancreatitis
- D. Cirrhosis
- You are examining a patient who has yellowing of the eyes, an enlarged spleen, spider angiomas, and a rounded firm abdomen with enlarged veins. What does this patient likely have?
- A. Cirrhosis
- B. Hepatitis A
- C. Cholecystitis
- D. HIV
- PANRE Sample Questions
- An infant is born with microcephaly, deafness, chorioretinitis, hepatosplenomegaly, and thrombocytopenia. Which of the following diseases would NOT be a likely cause?
- A. Influenza
- B. Rubella
- C. Toxoplasmosis
- D. Cytomegalovirus
- Which of the following is NOT an appropriate intervention for a partial small-bowel obstruction?
- A. Antibiotics
- B. Intravenous (IV) fluids
- C. Nasogastric tube
- D. Antiemetic medications
- A 50-year-old woman has tingling and pain in her hands that is worse at night. She has worked in a job for years where she does a lot of typing. Phalen test is positive. Which nerve is affected?
- A. Radial
- B. Ulnar
- C. Musculocutaneous
- D. Median
- Which medication can be used to treat moderate pulmonary cryptococcosis in an immunocompromised patient?
- A. Fluconazole
- B. Nystatin
- C. Terbinafine
- D. Selenium
PANCE is a computerized, multiple-choice test consisting of 300 questions given in 5 blocks of 60 questions each. A total of one hour may be taken to complete a block of questions. Candidates may take breaks between blocks as needed, and can accrue up to 45 minutes in break time.
PANRE computer-based testing consists of 240 questions organized in 4 blocks of 60 questions each. You will be given up to an hour to complete each blocks with a total of 45 minutes allowed for breaks between blocks.
Both exams contain actual test items (“scored items”) as well as practice questions that are not scored (“pre-test items”). Pre-test items are used to evaluate new questions for future use, and your answers to these questions do not influence your overall score on the exam. Each test has multiple versions containing different questions.
Both exams are scored using similar algorithms that are designed to adjust for variations in the difficulty of scored items among different versions of the exam. Each correct answer is awarded 1 point; incorrect answers are given 0 points. The total is then added to give a raw score. Instead of comparing the raw score to a set number of points, the number of items answered correctly is used to calculate a proficiency measure, which is an adjusted score that can be used for comparison just as if everyone took exactly the same version of the exam. This measure is then scaled to compare with other test scores taken over time by different people. Because of this, the score you receive as a final result is a scaled score, rather than a percentage correct. Each scale has a different passing standard that is reported along with your final score. 
In 2014, the NCCPA launched a pilot program to evaluate the desirability of reintroducing the clinical skills portion of the PANCE which was eliminated in 1997, using an Objective Structured Clinical Examination (OSCE) paradigm. The pilot is expected to last up to 2 years and will include a cost/benefit analysis. The OSCE portion of the exam will require use of specially trained personnel to serve as “patients” for the case study and physical examination. The use of special testing center facilities may be required to implement this change, and it is not yet clear whether the cost of the examination will be increased accordingly. 
In 2014, the NCCPA is in the process of transitioning from a 6-year to a new, 10-year certification maintenance cycle. Changes will affect newly certified PA’s, those who re-take the PANCE after a lapse in certification, and PA-C’s whose 6-year maintenance cycle completes in 2014. Apart from some changes in CME requirements, there is no change to the cost, format, or enrollment process for the PANRE. 
Answers to Sample Questions
1;D 2;B 3;B 4;A 5;A 6;A 7;D 8;A
- The National Commission on Certification of Physician Assistants: History and Role September 29, 2014
- American Academy of Physician Assistants: Statutory and Regulatory Requirements for Licensure September 29, 2014.
- 2013 Statistical Profile of Certified Physician Assistants: An Annual Report of the National Commission on Certification of Physician Assistants September 29, 2014
- PANCE Pass Rates September 29, 2014
- PANCE September 29, 2014
- FAQs September 29, 2014
- PANRE September 29, 2014
- Guidelines for Special Accommmodations for Exam Takers With Disabilities September 29, 2014
- Test Day 10 October 2014
- Content Blueprint 10 October 2014
- Exam Development and Scoring September 29, 2014
- Clinical Skills Pilot Q&A September 29, 2014
- New Year, New Certification Maintenance Process: Bringing It Into FocusSeptember 29, 2014