Respiratory therapists work in a wide range of healthcare settings, though hospitals remain the dominant employer by a large margin. About 98,000 respiratory therapists work in general medical and surgical hospitals, making up roughly 75% of the profession. But the remaining quarter work across diverse environments, from sleep labs and rehab centers to patients’ living rooms and even helicopters.
Hospital Departments
Hospitals employ respiratory therapists across multiple specialized units, not just in one department. In intensive care units, they manage ventilators, assist with placing breathing tubes, and continuously monitor patients with severe respiratory failure. In neonatal intensive care units, they specialize in helping premature infants whose lungs haven’t fully developed, providing carefully calibrated oxygen therapy and other breathing support. Emergency departments rely on respiratory therapists as first responders for acute breathing crises, where they assess patients and deliver life-saving airway interventions within minutes of arrival.
Beyond these high-acuity settings, respiratory therapists also work in general medical floors, operating rooms (managing airways during surgery), and cardiopulmonary diagnostic labs where they run lung function tests that help physicians diagnose conditions like asthma, COPD, and pulmonary fibrosis.
Skilled Nursing Facilities
Skilled nursing facilities represent the third-largest employment sector for respiratory therapists, with roughly 4,760 positions nationally. In these settings, the work shifts from acute crisis management to long-term respiratory care. Patients in nursing facilities often need ongoing ventilator weaning, tracheostomy care, or regular breathing treatments for chronic lung disease. The pace differs from hospital work, but the clinical complexity can be significant, particularly in facilities that accept ventilator-dependent residents.
Home Health Care
Home-based respiratory care has grown as healthcare systems push to keep patients out of hospitals when possible. Respiratory therapists in home health assess patients in their own living spaces, set up and manage equipment like oxygen concentrators and portable ventilators, and teach patients and family members how to use devices safely. The American Association for Respiratory Care outlines several core responsibilities in this setting: patient assessment and monitoring, equipment implementation, disease management, and education for patients, families, and caregivers.
This role requires more independence than hospital work. You’re often the only clinician in the room, making real-time judgments about whether a patient’s condition is stable or deteriorating. Strong teaching skills matter here, since family members become the day-to-day caregivers between visits.
Sleep Labs and Sleep Centers
Sleep medicine is a natural fit for respiratory therapists, given that the most common sleep disorder (obstructive sleep apnea) is fundamentally a breathing problem. In sleep centers, respiratory therapists monitor polysomnography screens that display data from electrodes placed on the patient overnight. When they observe signs of a sleep disorder, they can initiate positive airway pressure therapy during the study itself, calibrating the pressure needed to keep the patient’s airway open.
Some Medicare administrative contractors require sleep-specific credentials to perform or score sleep disorder testing, so respiratory therapists working in this space often pursue additional certifications. Five of the 12 Medicare administrative contractors currently require a sleep-specific credential for any sleep disorder testing, making this a specialized but accessible career path for RTs willing to earn the extra qualification.
Pulmonary Rehabilitation Centers
Pulmonary rehabilitation programs serve patients with chronic lung conditions who need structured support to improve their breathing, endurance, and quality of life. These programs can be inpatient, outpatient, or home-based, and respiratory therapists play a central role in designing and supervising the therapeutic components.
Exercise training is the core of any pulmonary rehab program. Respiratory therapists guide patients through systemic exercise therapy, upper-extremity training to improve arm-specific exercise capacity, and inspiratory muscle training that strengthens the muscles used for breathing. Some programs incorporate breathing exercises from yoga or tai chi. Beyond exercise, respiratory therapists lead health education sessions that teach patients about their disease and provide the kind of behavioral coaching that research shows improves exercise tolerance and helps patients stick with their treatment plans. Psychosocial support is also part of the picture, reducing breathlessness in the short term and improving compliance over time.
Physician Offices
About 2,450 respiratory therapists work in physician offices, typically pulmonology or allergy practices. In these outpatient settings, the focus is on diagnostic testing (spirometry, bronchial challenge tests) and patient education rather than acute care. Respiratory therapists here spend more time teaching patients how to use inhalers correctly, manage their medications, and recognize warning signs of worsening symptoms. The average hourly wage in physician offices runs about $36.37, slightly lower than the $38.48 hospital average.
Specialty Hospitals
Specialty hospitals, excluding psychiatric and substance abuse facilities, employ around 7,500 respiratory therapists. These include long-term acute care hospitals that manage patients requiring extended ventilator support, children’s hospitals, and rehabilitation hospitals. The concentration of respiratory therapists in these facilities is actually higher relative to total staff than in general hospitals, with 2.63 RTs per thousand employees compared to 1.72 in general hospitals.
Medical Transport Teams
Flight respiratory therapy is one of the more demanding and specialized career paths. Flight RTs work on air and ground transport teams, caring for critically ill patients during helicopter or fixed-wing transfers between facilities. Children’s Hospital Colorado, for example, requires four years of critical care or emergency department experience, plus certifications in advanced life support, pediatric advanced life support, neonatal resuscitation, and a neonatal or pediatric transport certification within two years of hire.
During transport, respiratory therapists must assess patients and adjust therapies in real time as conditions change, all within the confined space of an aircraft while following strict safety regulations. This role demands the ability to make independent clinical decisions quickly, since backup resources are limited at 3,000 feet.
Education and Leadership Roles
Experienced respiratory therapists can move into teaching or administrative positions without leaving the profession entirely. Within hospitals, senior RTs serve as technical resources for physicians on current respiratory care practices and train newer practitioners. These roles can expand to include scheduling staff, developing clinical and administrative policies and procedures, leading quality improvement initiatives, and serving on hospital committees.
Outside hospitals, respiratory therapists teach in college and university programs that train the next generation of RTs. Academic positions typically require a master’s degree and several years of clinical experience. Some RTs also move into medical device sales, consulting, or case management roles for insurance companies, leveraging their clinical expertise in non-clinical settings.