Becoming a respiratory care practitioner requires completing an accredited degree program, passing national credentialing exams, and obtaining a state license. The full process takes two to four years depending on the degree level you choose. Here’s what each step involves and what to expect along the way.
Choose the Right Degree Program
You need at minimum an associate degree in respiratory care, which takes about two years. A bachelor’s degree takes four years and is increasingly becoming the standard. Many employers now prefer or require a bachelor’s, and some schools have even launched master’s degree programs in the field. If you’re weighing your options, starting with an associate degree gets you working sooner, but a bachelor’s opens more doors for advancement and may be required for supervisory or teaching roles down the line.
Whichever degree level you pursue, the program must be accredited by the Commission on Accreditation for Respiratory Care (CoARC). This isn’t optional. Graduating from a CoARC-accredited program is a prerequisite for sitting for the national credentialing exams, which you need to get licensed. CoARC accredits programs at the associate, bachelor’s, and master’s levels, so you have flexibility in how you enter the profession.
What You’ll Study and Practice
Respiratory care programs blend classroom science with hands-on clinical training. Coursework covers anatomy and physiology, cardiopulmonary disease, pharmacology, and the mechanics of ventilation and airway management. You’ll learn to interpret diagnostic tests, manage life-support equipment, and treat patients across the age spectrum, from premature newborns to elderly adults in intensive care.
Clinical rotations are a major component. Students at a typical associate program complete roughly 900 hours of supervised practice in hospitals and other healthcare settings, including teaching hospitals where you’ll see a wide range of cases. These rotations let you work directly with patients under the guidance of experienced therapists, and they’re where most students figure out which area of respiratory care appeals to them most.
Pass the National Credentialing Exams
After graduating, you’ll need credentials from the National Board for Respiratory Care (NBRC). The process starts with the Therapist Multiple-Choice (TMC) Examination: 160 questions over three hours, covering the full scope of respiratory care practice.
The TMC has two scoring thresholds that determine which credential you earn:
- Low cut score: Earns you the Certified Respiratory Therapist (CRT) credential.
- High cut score: Earns you the CRT and makes you eligible for the next exam, the Clinical Simulation Examination (CSE).
The CSE is a four-hour exam with 22 scenario-based problems designed to simulate real clinical situations. Passing it earns you the Registered Respiratory Therapist (RRT) credential, the higher of the two designations. Most employers prefer or require the RRT, so aiming for the high cut score on the TMC and completing the CSE is well worth the effort. Note that hitting the high cut score alone doesn’t automatically qualify you for the CSE. You must also meet separate eligibility requirements set by the NBRC.
Get Your State License
Nearly every U.S. state requires respiratory therapists to hold a license or permit to practice. State requirements vary but generally include proof of graduation from an accredited program, NBRC certification, and an application with your state’s respiratory care board. Some states require background checks, and most mandate continuing education credits to maintain your license over time. Check with your state’s licensing board for the specific requirements where you plan to work.
What You’ll Do on the Job
Respiratory care practitioners work primarily in hospitals, though you’ll also find positions in sleep labs, rehabilitation facilities, home health agencies, and physician offices. The core of the work revolves around helping people who have difficulty breathing, whether from chronic conditions like COPD and asthma, acute emergencies like trauma, or critical illness requiring mechanical ventilation.
Day-to-day tasks include managing ventilators for critically ill patients, performing pulmonary function tests to assess lung capacity, drawing arterial blood samples for gas analysis, administering inhaled medications, and responding to emergency codes when a patient’s airway is compromised. In some hospital settings, regulations specify that ventilator patients require a staffing ratio of one therapist for every four patients, reflecting the intensity of that particular responsibility. You’ll also spend time educating patients and families on managing respiratory conditions at home.
Specialty Credentials
Once you’ve established yourself as an RRT, you can pursue specialty certifications that validate expertise in specific patient populations. Two of the most recognized are offered by the NBRC:
- Adult Critical Care Specialist (RRT-ACCS): Validates advanced knowledge and skills in adult critical care, relevant if you work in intensive care units.
- Neonatal/Pediatric Specialty (NPS): Confirms expertise in caring for infants and children with respiratory conditions, common in neonatal intensive care units.
These credentials aren’t required to work in those areas, but they signal a higher level of competence to employers and can factor into hiring, promotions, and pay.
Salary and Job Outlook
Respiratory therapists earned a median annual salary of $80,450 as of May 2024, according to the Bureau of Labor Statistics. Employment in the field is projected to grow 12 percent from 2024 to 2034, which is much faster than the average for all occupations. An aging population and the prevalence of chronic respiratory diseases are driving that demand. Therapists with a bachelor’s degree and the RRT credential are positioned most competitively in this job market.