TL;DR: The PANRE is the exam PAs take to keep their NCCPA certification. You have to pass it once every 10 years, and you get two ways to do it: the traditional PANRE (240 questions in a test center, years 9 or 10) or the PANRE-LA (25 questions a quarter, online, years 7 to 9). Either one costs $350 and covers the same content.
Brian Wallace, PA-C. I’ve worked with PA students for 15 years and I run 33 Days to Pass the PANCE. Updated October 2026.
What is the PANRE?
It’s the Physician Assistant National Recertifying Examination, and it’s how you keep the “C” in PA-C.
You passed the PANCE to get certified. The PANRE is how you prove, every 10 years, that you’ve still got it. It’s run by the NCCPA, same as the PANCE.
I’ve taken the PANRE twice, and I’m in the middle of the PANRE-LA right now. So I’ve been on both sides of this one.
How often do you have to take the PANRE?
Once every 10 years.
NCCPA runs certification on a 10-year cycle made of five two-year chunks. Every two years you log 100 CME credits and pay the certification maintenance fee by December 31 of your expiration year. Somewhere in years 7 through 10 you pass the exam.
If you remember it as every six years, you’re not crazy. That’s how it used to work. It’s 10 now.
PANRE or PANRE-LA: what’s the difference?
Same content, same fee, very different experience.
| PANRE | PANRE-LA | |
|---|---|---|
| When | Years 9 or 10 | Years 7 to 9 (apply in year 6) |
| Where | Pearson VUE test center, proctored | Online, wherever you are |
| Questions | 240 in one day | 25 a quarter, over up to 12 quarters |
| Time | 4 hours of testing (5-hour appointment) | 5 minutes per question |
| References | Not allowed | Books and websites allowed, other people not |
| Feedback | Results about two weeks later | Right answer and explanation after every question |
| Cost | $350 | $350 |
The PANRE is one hard day and then you’re done. The PANRE-LA is a little at a time, spread over a few years, and you learn something from every question.
How many questions are on the PANRE, and how long is it?
240 questions, four hours.
The PANRE is four blocks of 60 questions, with 60 minutes for each block. You get 45 minutes of break time to split between blocks and 15 minutes for the tutorial, so plan on a five-hour appointment. It’s proctored at a Pearson VUE center, and you can’t bring in any references.
You can take it in year 9 or year 10. You get up to two tries in year 9 and up to three in year 10, with a maximum of four total, and you have to wait 90 days between attempts.
How does the PANRE-LA work?
25 questions a quarter, five minutes each, from home.
You apply in year 6 and start in January of year 7. From there you get 25 questions every quarter for up to 12 quarters, through year 9. You can log in and out whenever you want during the quarter.
A few rules worth knowing:
- You have to be currently certified and apply in year 6. If your certification has lapsed, or you miss the application window, it’s the regular PANRE
- You have to do at least one quarter in year 7 and one in year 8
- You can skip quarters, but if you finish with fewer than eight, every missing quarter counts as all wrong
- Your score is your best eight quarters, so you can finish in as few as eight
- Once you pass, you’re done
- You can use books and websites, but not other people
One thing that sets it apart: after every question you see the right answer, why it’s right, why the others are wrong, and where to read more. Each quarter you finish also counts as 2 Category 1 Self-Assessment CME credits.
How much does the PANRE cost?
$350, whichever version you take.
That’s NCCPA’s fee for either the PANRE or the PANRE-LA. It’s separate from the certification maintenance fee you pay every two years.
What happens if you don’t pass?
You get more chances, but the clock is real.
If you don’t pass the PANRE, you can take it again after 90 days, up to the attempt limits above. If you don’t pass the PANRE-LA after 12 quarters, you get up to three attempts at the regular PANRE in year 10 before your certification expires.
So the PANRE-LA isn’t all-or-nothing. If it doesn’t go your way, you still have year 10.
How do I study for the PANRE?
Start sooner than you want to, and do questions.
Here’s the hard part, and it hasn’t changed since I first wrote about this. Knowing you have to take the PANRE and committing to take it are two different things. two different things
You haven’t sat for an exam in years. You have little or no interest in most of the topics you need to review. You see one slice of medicine every day, and the test covers all of it.
Regardless, at some point you have to choose to take the exam and prepare for it.
What works for the PANRE is what works for the PANCE. Active studying beats passive reading. Questions beat rereading. And when you miss one, figure out why you missed it, not just what the answer was.
Christine said it better than I can. She’d missed the PANRE by six points the first time:
“My tip for others would be to do as many exam questions as they can. It got me into the test-taking mode, and like you said, active learning is much better than passive learning and retention was much higher.”
She passed on her second try.
If you’re working through lookalike answer choices, I wrote about how to tell them apart in How do I tell lookalike answer choices apart on the PANCE? Same test writers, same rules.
If exams have been hard for you before
If you struggled on exams in the past and you have to sit for the PANRE, 33 Days might be for you.
33 Days to Pass the PANCE is built around the skills that decide your score: studying, clinical reasoning, test taking, and the content itself. Those skills don’t care whether the letters on the exam are PANCE or PANRE. same skills
Not ready for that? Get my daily lesson instead. It’s free.
Questions PAs ask me about the PANRE
Should I take the PANRE or the PANRE-LA?
If you’d rather learn a little at a time with references open, the PANRE-LA. If you’d rather study hard for a stretch and be done in one day, the PANRE. Both cost $350 and cover the same content.
Can I use resources on the PANRE-LA?
Yes. Books and websites are allowed. Getting help from another person isn’t, and you can’t paste the question or answer choices into a search engine, website, or AI tool. Searching keywords is fine.
Do I need my CME done before I take the PANRE?
No. You don’t have to submit CME before taking the PANRE for recertification. You still have to meet the CME and fee deadline for each two-year cycle. (If you’re taking it to regain a lapsed certification, the CME comes first.)
What if I don’t pass the PANRE-LA?
You get up to three attempts at the regular PANRE in year 10 before your certification expires.
Where can I see sample PANRE questions?
NCCPA posts sample PANRE and PANRE-LA questions on its site.
Want more?
If you’re looking to learn more, the podcast is a great free place to start.
