What Material Does the PANCE Cover? Is It Like the USMLE Where If I Am a Good, Hard-Working PA Student, I Should Pass With Not Too Much Difficulty?

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Graduating from one of the top physician assistant degree programs is a big step toward your career as a PA, but it’s not the end of your path. Before you can start practicing medicine under the watchful eye of a supervising doctor, you need to obtain a state-issued license. To get this license, you must earn a passing score on the PANCE test, according to the United States Bureau of Labor Statistics (BLS). Read on to learn more about what is on the PANCE exam and how hard this licensing exam is to pass.

DegreeQuery.com is an advertising-supported site. Featured or trusted partner programs and all school search, finder, or match results are for schools that compensate us. This compensation does not influence our school rankings, resource guides, or other editorially-independent information published on this site.

An Overview of the PANCE Physicians Assistant Test

What exactly is the PANCE? The Physician Assistant National Certifying Examination, administered by the National Commission on Certification of Physician Assistants (NCCPA), is an essential part of acquiring your license to work as a physician assistant.

PAs perform the work of practicing medicine in a clinical capacity, but they aren’t doctors. Instead, they work in collaboration with and under the supervision of fully licensed physicians who have attained their Doctor of Medicine (MD) or Doctor of Osteopathic Medicine (DO) degree. Although there are some differences in the education, training and job duties of PAs compared to physicians, one of the many similarities between these two career paths is the need for professional licensure. Like doctors, physician assistants face the requirement to pass a licensing exam – but not the same licensing exam – to attain the credential needed to practice. Passing the PANCE exam qualifies a candidate to use the credential and official title “Physician Assistant-Certified,” or PA-C, according to the BLS.

The PANCE licensing test covers the basic generalist knowledge of different types of disease and the knowledge and skills needed to treat medical conditions. Statistically, the pass rate for the PANCE test is high, but you still need to study sufficiently to prepare for the exam.

In addition to passing the PANCE once for initial licensure, certified physician assistants must complete continuing education requirements to maintain certification in good standing and pass a recertification exam. The traditional PANRE recertification test must be completed every 10 years, but beginning in 2023, licensed PAs may choose to undertake the new PANRE-LA recertification process

How Hard Is the PANCE Test for Physician Assistants?

Is the PANCE test hard? This is a common question, particularly among prospective PAs who chose the career path because it seemed easier, at least in some ways, than becoming a physician.

The good news is that most aspiring physician assistants successfully complete the PANCE exam. Among test-takers who fail the PANCE, they often fall short of a passing score by only a relatively small amount and are able to make improvements to pass the test on the next attempt.

Still, the content of the PANCE test is challenging. After all, it’s a test intended only for examinees who have already completed a master’s degree program in physician assistant studies, including classroom, laboratory and clinical work. Since this test is a mandatory part of acquiring a license to work in clinical practice, test-takers are naturally expected to demonstrate that their knowledge of medicine is sufficient to practice medicine on real patients in clinical settings. As such, it would be a mistake to go into the exam under the impression that the questions will be easy simply because the pass rate is fairly high.

While the majority of test-takers do pass the PANCE, they typically do so because they take the test seriously, studying hard and in accordance with a sound study plan. Test-takers are certainly permitted to work in roles other than licensed PA while they prepare for the exam, but some physician assistants advise treating studying for the PANCE test as a full-time job to avoid spreading one’s attention and efforts too thin to pass the exam.

What Does It Mean to Pass the PANCE?

Part of what makes passing the PANCE test intimidating is that there isn’t even a clearly identified percentage of questions you must need to get right to earn a passing score. The lowest possible reported score on the PANCE is 200, and the highest possible score is 800. Test-takers need a score of at least 350 to pass the exam.

However, because the NCCPA scores the multiple forms of the PANCE test on a scaled score that is based on the performance of a reference group, the percentage of correct answers needed for a “passing score” is not the same for all versions of the exam, and consequently, the NCCPA does not currently publish a minimum percentage for a passing score.

Obviously, the goal of a PANCE test-taker is to get the largest possible number of questions right.

PANCE Exam Pass Rate

According to the NCCPA, the PANCE exam pass rate is consistently above 90 percent among both first-time test-takers and all test-takers. Between 2016 and 2020, the lowest passing rate among all test-takers was 91 percent, in 2019, and the highest passing rate was 97 percent, in 2018. Similarly, pass rates among first-time test-takers were lowest in 2019, with 93 percent of examinees passing the test, and highest in 2018, with 98 percent of candidates passing the exam.

In 2020, test-takers passed 93 percent of the 10,687 exams administered, and 95 percent of the 9,990 first-time test-takers passed the exam. All in all, 9,915 test-takers passed the PANCE during 2020.

As professional exams go, the PANCE test has a higher passing rate than tests in many other professions, a fact that can make the exam sound easier than it really is. The PANCE pass rate is close to the pass rate doctors achieve on the United States Medical Licensing Examination (USMLE) exam, which has generally hovered around the mid-90th percentage. In comparison, pass rates for the bar exam that attorneys take have been in the high 80s in recent years, according to the American Bar Association Journal.

For accountants pursuing the certified public accountant (CPA) credential, exam pass rates are around 50 percent, although some portions of this four-part exam tend to see higher pass rates than others. For actuaries, the pass rate on the series of exams needed for full professional qualification is 30 to 40 percent.

If you do well in your PA graduate program, you’re likely to do well on the exam – but you still need to study.

What Happens If You Don’t Pass the PANCE?

If you don’t pass the PANCE, you can’t become a licensed PA authorized to practice medicine in any state in the U.S. Earning a passing score on this exam is required for licensure in every state and in Washington, D.C., according to the BLS.

However, you don’t get only one shot at passing this exam. Candidates can take the PANCE multiple times if required – up to six times total during the six years following the completion of your PA master’s degree program, according to the NCCPA. If you do fail the PANCE test, you must wait 90 days to retake the test, and you may not attempt the test more than three times in a calendar year.

For a test-taker who takes and fails the PANCE the full six times allotted or who otherwise fails to pass it within the six years after graduating with their master’s degree, getting into this career will become much more challenging. The candidate is no longer eligible to sit for the exam unless they start over from scratch and complete a PA master’s degree program all over again. Naturally, getting into such a program is difficult after already earning this degree, and doing the work all over again is a daunting prospect. Since the stakes are so high, it’s important that aspiring physician assistants pass their licensing tests on earlier, rather than later, attempts.

Most people who graduate from a physician assistant master’s degree program will pass the PANCE test at some point, if not on their first try. A candidate who finds that they are having trouble passing the test can take advantage of a variety of different strategies, study plans and preparation courses to improve their scores in the future.

Taking official NCCPA Practice Exams, which cost $50 per exam, is one way that test-takers can get an idea of what their strengths and weaknesses are so they can identify what topics they need to study most extensively in preparation for the test. Additionally, PANCE score reports provide test-takers with subscores that are specific to each content area on the exam. Reviewing these content area subscores can help you determine where you struggled most and which parts of the test you most need to focus on as you study to retake the exam.

One way to improve your chances of passing the PANCE exam is by choosing a school with a high pass rate, which suggests that the curriculum of that program does an exceptional job covering the exam content. Some PA programs have pass rates as high as 100 percent.

What Is on the PANCE Exam?

The exam consists primarily of medical content, which makes up 95 percent of the test. The other 5 percent of content fits into the category of issues in professional practice. Although the PANCE test is generalized in nature, up to 20 percent of it may focus on topics in general surgery. Altogether, takers of the PANCE test must complete 300 multiple-choice questions, split into five 60-minute blocks, which short breaks in between.

The Content of the PANCE Exam

What exactly is on the PANCE test? Content is divided into categories of medical systems or specialties and medical tasks. On the 2019 PANCE content blueprint, the largest portion of the medical content category is the cardiovascular system, which makes up 13 percent of questions on medical systems. Next is the pulmonary system, which makes up 10 percent, followed by the gastrointestinal system, which makes up 9 percent, and the musculoskeletal system, which accounts for 8 percent of the questions. The endocrine system, neurologic system, reproductive system and eyes, ears, nose and throat system each command 7 percent of the content of this portion of the exam. Both infectious diseases and psychiatry and behavioral science account for 6 percent of the content. The dermatologic system, genitourinary system, hematologic system and renal system each make up 5 percent of the content.

When it comes to tasks, more than half of the content on the PANCE test has to do with managing patients in some capacity. Both pharmaceutical therapeutics and clinical intervention make up 14 percent of this section of the test. Applying basic scientific concepts and health maintenance, patient education and preventive measures both make up another 10 percent of the content.

Beyond the category of managing patients, the largest share of this content is formulating the most likely diagnosis, which makes up 18 percent of questions. The tasks of taking patients’ medical histories and conducting physical exams make up 17 percent of the test, while using diagnostic and laboratory studies accounts for 12 percent of questions.

One of the biggest challenges for test-takers is managing their time throughout the course of the lengthy multi-part exam. On average, you need to complete one question each minute to finish answering every question before you run out of time.

PANCE vs. USMLE Tests for Careers Practicing Medicine

Both the PANCE and the USMLE are licensing tests used to qualify medical professionals for licensure, and as noted above, these tests have fairly similar pass rates. They aren’t, however, interchangeable. A candidate with an MD can’t become a doctor by passing the PANCE – and, in fact, isn’t even eligible to sit for the PANCE – and an aspiring PA can’t swap the USMLE for the PANCE.

One big difference between the PANCE and the USMLE is the test format. While test-takers take the sections of the PANCE all at once, the USMLE is divided into three steps. Step 1 is an eight-hour exam that encompasses 280 multiple-choice questions that aim to evaluate the test-taker’s knowledge of basic sciences and their ability to apply these concepts to the clinical practice of medicine. Questions on this test might cover topics of the mechanisms that contribute to health, disease and treatments.

Step 2 of the USMLE is another one-day test, this time consisting of 318 multiple-choice questions administered over a period of nine hours. In this step of the USMLE exam process, test-takers answer questions about the clinical science and medical skills used to care for patients, promote health and prevent disease. Finally, Step 3 is a two-day test that consists of 232 multiple-choice questions on the Foundations of Independent Practice (FIP) and 180 multiple-choice questions plus 13 computer-based case simulations pertaining to Advanced Clinical Medicine (ACM).

The USMLE is mandatory for licensure as a doctor with an MD degree, but it isn’t the only licensure exam for physicians in the United States. Doctors who train for their careers through a DO program, instead of an MD program, instead take the Comprehensive Osteopathic Medical Licensing Examination (COMLEX-USA) for licensure. 

Additional Resources

How Does an Aspiring PA Prepare for the PANCE Test? Are There Reputable Prep Courses?

Do PAs Have to Take the Same Boards as an MD?

Does a PA Have a Medical License?