Respiratory therapy is a genuinely demanding career, both intellectually and emotionally. The licensing exams have first-time pass rates below 63%, the physical work involves 12-hour shifts on your feet, and recent surveys put burnout rates among respiratory therapists between 74% and 79%. That doesn’t mean it’s the wrong career, but anyone considering it should understand exactly where the difficulty comes from.
The Schooling and Exams Are Harder Than Expected
Most respiratory therapy programs take two years for an associate degree or four years for a bachelor’s. The coursework covers anatomy, physiology, pharmacology, cardiopulmonary science, and the physics of gas exchange. It’s science-heavy from day one, and clinical rotations begin early, meaning you’re applying complex material in hospital settings while still learning it.
The real filter, though, is the credentialing process. To become a Registered Respiratory Therapist (RRT), you need to pass two national board exams administered by the NBRC. In 2024, only 55.6% of first-time candidates passed the Therapist Multiple-Choice Examination. The Clinical Simulation Examination, which tests decision-making through patient scenarios, had a 62.9% first-time pass rate. Roughly 4 out of 10 people who sit for these exams don’t pass on their first attempt. That’s a significant hurdle, and it reflects how much critical thinking the profession requires beyond memorization.
What You Actually Do in a Hospital
The core of respiratory therapy is managing how patients breathe. In a general ward, that might mean administering breathing treatments, educating patients with asthma or COPD, and monitoring oxygen levels. In the ICU, the work escalates quickly. You manage mechanical ventilators for the sickest patients in the hospital, draw and analyze blood gases to assess oxygen and carbon dioxide levels, assist with bronchoscopies, administer specialized gases like nitric oxide, and monitor hemodynamic data that tracks how well the heart and lungs are working together.
You’re not working in isolation. At the NIH Clinical Center, respiratory therapists function as active partners with ICU physicians and nurses in managing patients with complex oxygenation and ventilation problems. That collaborative role sounds rewarding on paper, and it often is, but it also means you’re expected to think critically under pressure and speak up when something isn’t right. If a ventilator alarm fires at 3 a.m. and the settings need adjusting before a doctor arrives, you’re the one making that call.
As you gain experience, the technical expectations grow. Advanced practice respiratory therapists work with complex ventilation strategies, extracorporeal gas exchange (machines that oxygenate blood outside the body), and sophisticated pulmonary function testing. The learning curve doesn’t flatten after school. It steepens.
The Physical Toll of 12-Hour Shifts
Respiratory therapy is not a desk job. You’ll stand and walk for the majority of a shift that commonly runs 12 hours, moving between patient rooms, emergency departments, and ICU beds across an entire hospital. The physical standards for the profession include lifting up to 50 pounds, carrying up to 25 pounds, and pushing or pulling wheeled equipment weighing up to 250 pounds.
Because hospitals never close, your schedule will rotate through nights, weekends, and holidays. A common pattern is three 12-hour shifts per week, which sounds manageable until you’re working your third consecutive night shift and responding to a code blue at 4 a.m. The irregular hours disrupt sleep patterns and make it harder to maintain routines outside of work. If predictable 9-to-5 hours matter to you, this is worth factoring into your decision.
The Emotional Weight Is Real
This is the part of the job that catches people off guard. Respiratory therapists are often the last clinicians at the bedside. When a decision is made to withdraw life support, a respiratory therapist is typically the one who turns off the ventilator. You’re present for some of the most painful moments a family will ever experience, sometimes multiple times in a single shift.
A survey published in the Canadian Journal of Respiratory Therapy found that the biggest barriers to end-of-life care for respiratory professionals weren’t technical. They were human. Over 91% of respondents cited family difficulty accepting a patient’s prognosis as a major challenge. Nearly 88% pointed to patients themselves struggling to accept their limitations. On the provider side, about 74% of respiratory therapists reported lacking adequate training to navigate these conversations, and 71.5% said they simply didn’t have enough time to do it well.
That gap between what the job asks of you emotionally and the support you receive to handle it creates real strain over time.
Burnout Rates Are Among the Highest in Healthcare
The numbers here are sobering. A 2023 review in a respiratory care journal reported burnout rates among respiratory therapists as high as 79%, with contributing factors including poor leadership, inadequate staffing, high workloads, and difficult work environments. During the COVID-19 pandemic, a longitudinal study of 296 clinicians found that 74% of respiratory therapists experienced burnout symptoms, higher than physicians (30%), pharmacists (67%), and advanced practice providers (68%).
Other studies found that 50% of respiratory therapists were emotionally exhausted, and 26% met criteria for severe burnout. Secondary traumatic stress, the psychological impact of repeatedly witnessing other people’s suffering, affected 79% of respiratory therapists in one survey. These aren’t outlier findings. Multiple studies consistently place RTs near the top of burnout rankings across healthcare professions.
The pandemic amplified existing problems, but it didn’t create them. Staffing shortages mean you’re often covering more patients than is ideal. The emotional demands of critical care compound over months and years. And unlike physicians or nurses, respiratory therapists have historically received less institutional attention when it comes to wellness programs and mental health support.
What Makes It Worth It for People Who Stay
Despite all of this, respiratory therapy has strong career fundamentals. The Bureau of Labor Statistics projects faster-than-average job growth for the profession, driven by an aging population and rising rates of chronic respiratory conditions like COPD. Job security is strong. Hospitals, long-term care facilities, and home health agencies all need respiratory therapists, and the specialized credentialing means you can’t easily be replaced by someone from another discipline.
The work itself, when it goes well, is deeply satisfying in a way that’s hard to replicate in less intense fields. You help people breathe. You watch patients come off ventilators and walk out of the ICU. You’re trusted with life-or-death decisions in real time. For people who thrive on clinical problem-solving and can develop healthy coping strategies for the emotional side, respiratory therapy offers a career with genuine meaning and solid stability.
The honest answer to whether it’s hard is yes, consistently, in multiple dimensions. The question worth sitting with is whether the specific kind of hard it presents is one you’re built for or willing to grow into.