NCCPA
PANCE
Physician Assistant National Certifying Examination
The national certifying exam every physician assistant must pass to earn the PA-C credential, which all US states require for PA licensure. The single gateway between PA school and clinical practice.
Blueprint-complete program: 15 decks, 1,319 cards.
What's on the exam
PANCE Content Blueprint (effective January 2025)
Cardiovascular System
11%Coronary artery disease · Heart failure · Arrhythmias · Valvular disease · Hypertension · Vascular disease
Dermatologic System
4%Eczematous and papulosquamous disorders · Skin infections and infestations · Skin cancers · Acneiform disorders · Drug eruptions
Endocrine System
6%Diabetes mellitus · Thyroid disorders · Adrenal disorders · Pituitary disorders · Lipid disorders
Eyes, Ears, Nose, and Throat
6%Eye disorders (glaucoma, conjunctivitis, retinal disease) · Otitis and hearing loss · Sinusitis and rhinitis · Pharyngitis · Vertigo
Gastrointestinal System / Nutrition
8%GERD and peptic ulcer disease · Hepatobiliary disease · Inflammatory bowel disease · GI bleeding · Pancreatitis · Nutritional deficiencies
Genitourinary System
4%Urinary tract infections · Nephrolithiasis · Benign prostatic hyperplasia · GU cancers · Erectile dysfunction
Hematologic System
5%Anemias · Coagulation disorders · Leukemias and lymphomas · Thrombocytopenia · Hemoglobinopathies
Infectious Diseases
7%Bacterial infections and sepsis · Viral infections (HIV, hepatitis) · Fungal and parasitic infections · Sexually transmitted infections · Vaccination
Musculoskeletal System
8%Fractures and dislocations · Osteoarthritis and rheumatologic disease · Back and spine disorders · Sprains, strains, and overuse injuries · Compartment syndrome
Neurologic System
7%Stroke and TIA · Seizure disorders · Headache · Movement disorders · Peripheral neuropathies
Psychiatry / Behavioral Science
7%Depressive and bipolar disorders · Anxiety disorders · Psychotic disorders · Substance use disorders · Eating disorders
Pulmonary System
9%Asthma and COPD · Pneumonia · Pulmonary embolism · Lung cancer · Pleural disease · Obstructive sleep apnea
Renal System
5%Acute kidney injury · Chronic kidney disease · Fluid and electrolyte disorders · Acid-base disorders · Glomerular disease
Reproductive System
7%Pregnancy and prenatal care · Complications of pregnancy · Menstrual disorders · Contraception · Breast and gynecologic cancers
Professional Practice
6%Medical ethics · Patient safety and quality improvement · Legal and regulatory issues · Communication and cultural humility · Public health
Frequently asked questions
How much does the PANCE cost?
The PANCE costs $550. Plus state licensure fees.
How long is the PANCE and how many questions does it have?
300 items — 5 hours of testing (plus scheduled break time).
What do you need to pass the PANCE?
Scaled score above the NCCPA passing standard (pass/fail).
Can you retake the PANCE?
After 90 days; limited attempts per year and 6 attempts total within 6 years of graduation.
What is the best way to study for the PANCE?
Study the official blueprint, not random material: the exam is weighted by domain (Cardiovascular System 11%, Dermatologic System 4%, Endocrine System 6%, Eyes, Ears, Nose, and Throat 6%, Gastrointestinal System / Nutrition 8%, Genitourinary System 4%, Hematologic System 5%, Infectious Diseases 7%, Musculoskeletal System 8%, Neurologic System 7%, Psychiatry / Behavioral Science 7%, Pulmonary System 9%, Renal System 5%, Reproductive System 7%, Professional Practice 6%). Spaced-repetition flashcards built domain-by-domain against that blueprint are the most time-efficient way to cover everything the exam tests.
Ready to prepare?
Our PANCE program follows this exact blueprint — every domain covered, scheduled by spaced repetition, with a journey from first card to test day.