What’s the Difference Between NP and PA Certification Exams?

In the ever-evolving landscape of healthcare, the roles of Nurse Practitioners (NPs) and Physician Associates (PAs) have become increasingly vital. Both professions require rigorous certification, but what sets their certification exams apart? Join us on a journey to unravel the nuances and distinctions between NP and PA certification exams. From eligibility to testing formats, pass rates, and renewal requirements, we'll explore the intricacies of these crucial milestones in the careers of healthcare professionals. Whether you're an aspiring NP or PA or simply curious about the healthcare field, this comprehensive guide will illuminate the paths these professionals take on their journey to certification.

Certifying Bodies

Physician Associates (PAs) and Nurse Practitioners (NPs) follow distinct certification routes, each governed by different certifying bodies. Understanding these differences is crucial for aspiring healthcare professionals. 

PA Certification through NCCPA

NP Certification: A Choice of Bodies

PAs undergo certification through the National Commission on Certification of Physician Assistants (NCCPA). Central to this process is the Physician Assistant National Certifying Examination (PANCE). 

When it comes to nurse practitioners, there are a variety of certifying bodies available to NPs. Selecting a certifying organization depends on personal preference and the NP’s specialty. For the purposes of this article, we will focus on the two main nurse practitioner certifying bodies, the American Academy of Nurse Practitioners Certification Board (AANPCB) and the American Nurses Credentialing Center (ANCC).

Eligibility and Application

When it comes to eligibility to test and the application process, there is one significant difference between certification exams for NPs and PAs. Nurse practitioner applicants must have an active RN license in order to test whereas physician associate certification does not require additional licensure. 

Overall, PA students taking the PANCE may apply to take the test no sooner than 90 days prior to their expected program completion date and can take the certification exam as early as 7 days after their program completion date. NPs on the other hand, may request to sit for the certification exam prior to degree conferral and graduation provided that all of their didactic and clinical coursework is complete; though exam results and certification will be held until the NP is able to provide a final transcript showing they’ve graduated. Although nurse practitioners can test for certification sooner than PAs, neither will receive results or official certification prior to graduation.

Comparing Exam Length and Impact 

The physician associate certification exam is about twice as long as the certification exam for nurse practitioners. The PANCE consists of 300 multiple choice questions. PAs have 5 hours to complete the exam. 

Nurse practitioners certifying with the AANPCB, in contrast, take an exam consisting of 150 questions; of which 15 are pretest questions that do not count toward the total score and have 3 hours to complete the test. Each NP certification exam offered through ANCC contains 25 pretest questions and between 150 -175 scored questions and is 3.5 hours in duration. Overall, nurse practitioners can expect a shorter certification exam than physician associates which has benefits and drawbacks. While the exam may seem less arduous, each question has a greater impact on overall score.

Pass Rates: Who's on Top?

So, do NPs or PAs have more success when it comes to certification? Physician associates have significantly higher pass rates on the PANCE than do NPs certifying with the AANPCB or ANCC. 

Here are the stats on 2022 certification exam pass rates: 

PANCE Examination: 89% pass rate out of 12,460 exams.  (H3)
AANPCB Exam: 74% pass rate out of 20,180 total exams (includes FNP, AG-NP, Emergency NP Specialty examinations) (H3)
ANCC Exam: 87% pass rate out of 19,238 total NP exams (H3)

While these passing rates show which profession has greater certification success, rates do not necessarily correlate with the difficulty of questions or exam content.

Scoring and Retesting

Nurse practitioners are fortunate in that candidates receive a preliminary analysis which will indicate whether they have passed or failed the test immediately after they’ve completed the exam. Physician associates on the other hand play the waiting game. PANCE results are posted to the candidate’s online record, approximately two weeks after the exam date. 

What happens if an NP or PA fails the certification test? Should the PA fail the exam, he or she may only take the PANCE once in any 90-day period, or three times in one calendar year. The ANCC has similar guidelines for NPs. In the event that a candidate fails the exam, he or she may retest after 60 days and may not test more than three times in a 12-month period. The AANPCB differs, allowing NP test takers just two attempts at the certification exam each calendar year. 

PAs vs. NPs: Recertification Paths

The road to recertification diverges for PAs and NPs. PAs face periodic recertification exams, whereas NPs have different requirements. The major difference in certification renewal between NPs and PAs is that physician associates must take a test to re-certify whereas nurse practitioners do not. 

The NCCPA requires PAs to take a recertification exam called the PANRE at the end of every 10 years. The PANRE is organized similarly to the PANCE in that the subject matter covered is the same; however, it addresses broader clinical issues in 240 questions. In order to keep certification active, PAs must also earn and log a minimum of 100 credits of continuing medical education every two years.

Nurse practitioners must re-certify every five years. Recertification depends on completing continuing education hours, 75 hours every five years for the ANCC or 100 hours every five years for the AANPBC, in addition to completing a specified number of practice hours. NPs certified through the ANCC are required to re-certify through at least one of eight renewal categories as specified in the renewal requirement handbook so may need to meet additional criteria.

Create Your Physician Associate & Nurse Practitioner Board Certification Prep Strategy with ThriveJourney

As an aspiring APP, preparing for your board certification exam(s) can be overwhelming, with countless resources claiming to be the key to your success. In addition, everyone learns differently so there is no one right way to board prep. Understanding which tool or resources best fit your learning style and simplifying your NP or PA board prep process/ schedule will help you achieve your goal. The ThriveJourney Board Preparation Strategy Course will help you feel confident on test day. In our course Veronica Hill, DNP, CRNP discusses these key objectives:

  • Understand the Key Components of Successful NP or PA Board Certification Preparation
  • Identify the Most Common Board Preparation Resources on the Market
  • Test Day Preparedness
  • Discuss the Steps to Take if You Do Not Pass Board Certification
  • Review the Next Steps After Passing Your Board Certification


*Includes a downloadable Board Certification Planner & Board Preparation Resources Guide



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