How hard is the physician assistant exam?

Most graduates pass on their first attempt: 91.5% of first-time takers passed in 2025. What makes it hard is breadth and length: 300 clinical questions across every organ system in one sitting.

First-time pass rate, 2025	91.5%
First-time pass rate, 2021 to 2025	91.5% to 93.2%
Categories tested	14 organ systems plus professional practice
Pace	60 questions in each 60-minute block

Why it feels hard

Breadth: cardiovascular is the largest category at 11%, so no single system carries you. Dermatology and genitourinary questions count as much as any others.
Most questions are clinical vignettes that ask for the most likely diagnosis, the best next step or the right drug, with five plausible options.
Stamina: five hours of questions in one day, with only 45 minutes of break time to share between blocks.
Each question is also coded to a task, so you meet the same disease as a history question, a lab question and a treatment question.

What the numbers say

In 2025, 13,145 candidates took the exam for the first time and 91.5% passed. Counting every attempt, 88.4% of the 14,669 exams given were passes. Repeat takers pull the overall figure below the first-time rate.

How to check you are ready

Take a timed practice test and look at your result by category, not just the total. Fix the weakest high-weight category first, then sit a full 300-question practice exam in five timed blocks so the length holds no surprises.

Try 3 questions

Question 1

A 7-year-old girl has several episodes each day in which she stares blankly with fluttering eyelids for about 10 seconds, then abruptly resumes what she was doing without confusion. Hyperventilation in the office provokes an episode. Which of the following EEG findings is most expected?

Question 2

A 39-year-old man has 4 months of episodes of pounding headache, palpitations and drenching sweats lasting 10 to 20 minutes. During one episode his blood pressure was 190/110 mm Hg. Which of the following is the best initial test?

Question 3

A 35-year-old man twisted his right knee while squatting to lift a box. The next day the knee was swollen, and he now describes catching and occasional locking when he stands from a squat. Which of the following examination findings most supports the likely diagnosis?

Next step

Take the free practice test Start the free lab drill lesson

Questions people ask

Is the PANCE hard?

It is long and broad, but most graduates pass the first time: 91.5% of first-time takers passed in 2025.

What is the hardest part of the PANCE?

For most candidates it is the breadth: 15 categories, each tested through diagnosis, labs, treatment, prevention and science, over five hours of questions.

How long should I study for the PANCE?

NCCPA does not set a study period. A practical check is a timed practice test by category: once your weakest high-weight categories are fixed and a full-length practice exam goes well, you are close.