The Growing Demand for Respiratory Therapists in Modern Healthcare

Respiratory therapists (RTs) are essential clinicians who diagnose, treat, and manage patients with acute and chronic breathing disorders. Their expertise spans the entire lifespan—from premature infants fighting for their first breaths to elderly patients managing end-stage chronic obstructive pulmonary disease (COPD). The role combines technical mastery of life-support equipment with compassionate patient education, making it one of the most dynamic careers in allied health. With an aging population and increasing prevalence of respiratory illnesses, the need for qualified RTs continues to surge. This guide provides a thorough, step-by-step roadmap to earning your certification, securing state licensure, and building a lasting career in respiratory therapy.

Core Responsibilities and Daily Work of a Respiratory Therapist

Understanding what RTs actually do on the job helps clarify why training is so rigorous. In a typical shift, a respiratory therapist might:

  • Assess patients by measuring oxygen saturation, lung sounds, and breathing patterns
  • Administer aerosolized medications like bronchodilators and corticosteroids
  • Set up, monitor, and troubleshoot mechanical ventilators for patients in respiratory failure
  • Perform arterial blood gas (ABG) draws and interpret results to adjust therapy
  • Respond to cardiac or respiratory arrests as part of the code team
  • Educate patients on inhaler technique, pulmonary rehabilitation, and smoking cessation
  • Manage oxygen delivery systems, including high-flow nasal cannula and noninvasive ventilation

This variety keeps the work engaging but also demands a strong foundation in anatomy, physiology, pharmacology, and clinical decision-making—all of which are built during your educational program.

Educational Prerequisites and High School Preparation

Building a Strong Foundation in High School

The journey to becoming a certified respiratory therapist begins long before college applications. High school students interested in this field should prioritize courses in biology, chemistry, algebra, and health sciences. These subjects provide the scientific literacy needed for college-level respiratory care coursework. Communication arts are equally important: RTs must clearly explain complex procedures to anxious patients and document care accurately in electronic health records. Volunteering at hospitals or shadowing an RT can also confirm your interest and strengthen your applications.

College Prerequisites for Admission

Most accredited respiratory therapy programs require completion of prerequisite college courses before admission. Typical prerequisites include:

  • College algebra or statistics
  • Human anatomy and physiology I and II (with labs)
  • Microbiology
  • General chemistry
  • Introductory psychology
  • Medical terminology
  • Physics (some programs)

Admission can be competitive, especially for programs with limited clinical slots. A strong GPA in these courses (generally 3.0 or higher) and a solid score on any required entrance exam will improve your chances. Many programs also consider healthcare experience or shadowing hours.

Selecting a CoARC-Accredited Respiratory Therapy Program

Why Accreditation Is Non-Negotiable

Only graduates of programs accredited by the Commission on Accreditation for Respiratory Care (CoARC) are eligible to sit for the National Board for Respiratory Care (NBRC) certification exams. CoARC accreditation ensures that the curriculum meets rigorous national standards for didactic education and clinical training. Always verify a program’s accreditation status on the CoARC website before applying. Programs that lack this accreditation will not qualify you for certification, regardless of how well they teach.

Program Types and Degree Options

The most common entry point is a two-year Associate of Applied Science (A.A.S.) degree in respiratory therapy, offered at community colleges and technical schools. This is the fastest route to taking the NBRC exams and entering the workforce. However, many institutions now offer four-year Bachelor of Science in Respiratory Therapy (BSRT) degrees, which provide deeper training in leadership, research, and advanced clinical topics. Some BSRT programs are designed as completion degrees for RTs who already hold an associate degree. Additionally, certificate programs exist for individuals who already hold a bachelor’s degree in a related health field and wish to transition into respiratory therapy.

Online and hybrid programs are increasingly available, allowing students to complete didactic coursework remotely while arranging in-person clinical rotations at local hospitals. This flexibility can be a game-changer for working adults or those in rural areas.

Factors to Consider When Choosing a Program

  • Graduation rate and NBRC exam pass rates (especially first-time pass rates)
  • Clinical rotation sites and their quality (e.g., large teaching hospitals vs. small community facilities)
  • Program length and scheduling (full-time vs. part-time options)
  • Cost, financial aid availability, and scholarship opportunities
  • Faculty credentials and student support services

Talk to current students and program alumni to get an honest picture of the experience.

Detailed Curriculum: What You Will Learn

Core Didactic Subjects

A CoARC-accredited program covers a comprehensive range of topics over four to six semesters. Core subjects include:

  • Cardiopulmonary anatomy and physiology
  • Respiratory care pharmacology (e.g., bronchodilators, anti-inflammatories, mucolytics)
  • Patient assessment (history taking, physical exam, diagnostic tests)
  • Mechanical ventilation (basic to advanced modes, ventilator waveforms, weaning strategies)
  • Neonatal and pediatric respiratory care (including surfactant therapy and high-frequency ventilation)
  • Pulmonary rehabilitation and disease management (COPD, asthma, cystic fibrosis)
  • Advanced cardiac life support (ACLS) and neonatal resuscitation (NRP)
  • Polysomnography (sleep study) basics
  • Ethics, healthcare law, and interprofessional communication

Hands-On Lab Training

Programs dedicate significant time to laboratory practice where students develop psychomotor skills on mannequins and simulators. You will practice:

  • Airway management (intubation, bag-valve-mask ventilation, laryngeal mask airway insertion)
  • Arterial blood gas (ABG) collection and analysis
  • Ventilator setup, alarms, and troubleshooting
  • Chest physiotherapy and airway clearance techniques
  • Oxygen therapy delivery systems (nasal cannula, simple mask, Venturi mask, high-flow nasal cannula)
  • Performing spirometry and other pulmonary function tests
  • Responding to simulated emergency scenarios (code blue, difficult airway)

These labs build muscle memory and confidence before you ever touch a real patient.

Clinical Rotations: The Real-World Classroom

Clinical rotations are the backbone of respiratory therapy education. Students complete 400 to 800 hours in affiliated hospitals, rotating through multiple departments:

  • Intensive Care Unit (ICU): Managing ventilators, titrating oxygen, assisting with procedures like bronchoscopy
  • Emergency Department (ED): Rapid assessment and stabilization of acutely ill patients
  • Neonatal Intensive Care Unit (NICU): Caring for premature infants on ventilators or nasal CPAP
  • Pulmonary Function Lab: Conducting diagnostic tests such as spirometry, lung volumes, and DLCO
  • General Medical-Surgical Floors: Administering breathing treatments, educating patients, managing home oxygen
  • Sleep Lab: Setting up overnight sleep studies and scoring data

Under the supervision of experienced RTs, you will progress from observing to performing treatments independently. These rotations solidify your technical skills and help you decide which patient population you prefer.

The NBRC Certification Process: CRTT, CRT, and RRT

Understanding the Credentialing Levels

The National Board for Respiratory Care (NBRC) offers two main credentials: the Certified Respiratory Therapist (CRT) and the Registered Respiratory Therapist (RRT). While CRT is the entry-level certification, most employers (especially hospitals) require or strongly prefer the RRT, which represents advanced competency. In many states, you need at least the CRT to obtain a license, but the RRT gives you a competitive edge and higher pay.

Examination Sequence

The NBRC certification pathway involves two exams:

  1. Therapist Multiple-Choice (TMC) Exam: A 140-question exam covering all areas of respiratory care. Your score determines whether you qualify for the CRT (lower cut score) or the RRT (higher cut score).
  2. Clinical Simulation Exam (CSE): If you achieve the high cut score on the TMC, you move on to the CSE. This exam presents simulated patient scenarios where you make clinical decisions in a branching, interactive format. It tests your ability to gather data, interpret results, and choose appropriate therapies. Passing the CSE awards the RRT credential.

Both exams are computer-based and offered year-round at Pearson VUE testing centers. You must pass the TMC within three years of graduation and the CSE within three years of passing the TMC. Many graduates take the TMC immediately after finishing school while the material is fresh.

Effective Exam Preparation Strategies

Passing NBRC exams on the first attempt requires structured study. Use these resources:

  • NBRC self-assessment exams: Official practice tests that mirror the real exam format
  • Study guides from respected publishers: Books like "Respiratory Care: Principles and Practice" and NBRC-specific review guides
  • Online question banks: Platforms like Kettering Seminars, Respiratory Therapy Zone, and others offer thousands of practice questions with rationales
  • Study groups: Collaborating with classmates helps reinforce difficult concepts
  • Clinical simulation software: Practice CSE scenarios to become comfortable with the branching decision tree format

Aim to complete at least 200-300 practice questions per week in the month leading up to each exam. Analyze every mistake to fill knowledge gaps.

Certification through the NBRC is the gold standard, but it is not the same as a state license. In the United States, every state except Alaska requires respiratory therapists to hold a valid state license. The process generally involves:

  • Submitting proof of graduation from a CoARC-accredited program
  • Providing NBRC exam scores (CRT or RRT)
  • Completing a state application and paying a fee (typically $50–$200)
  • Passing a jurisprudence exam on state-specific laws (in some states)
  • Undergoing a criminal background check and fingerprinting

Some states offer temporary or provisional licenses that allow you to work while waiting for exam results. The American Association for Respiratory Care (AARC) maintains a comprehensive state-by-state guide to licensure laws. If you plan to relocate after graduation, check reciprocity rules—some states have mutual recognition, while others require additional steps.

Licenses must be renewed periodically, usually every one to two years, and require completion of continuing education units (CEUs). Most state boards accept AARC-approved education providers for CEU credit.

Employment Settings: Where Respiratory Therapists Work

Hospitals and Acute Care (The Majority Option)

Approximately 80% of respiratory therapists work in hospitals. Within that setting, you might find yourself in:

  • Adult ICUs: Managing ventilators, titrating sedation, and responding to acute respiratory deterioration
  • NICUs and Pediatric ICUs: Caring for critically ill newborns and children with respiratory distress, often using specialized ventilation modes
  • Emergency Departments: Stabilizing patients with asthma attacks, pneumonia, heart failure, or traumatic injuries
  • Operating Rooms and Recovery Rooms: Assisting anesthesia providers and managing post-surgical airway issues
  • Pulmonary Function Labs: Performing diagnostic testing to evaluate lung function

Extended Care and Rehabilitation Facilities

Long-term acute care hospitals (LTACHs) and skilled nursing facilities serve patients who require prolonged mechanical ventilation or weaning. RTs in these settings focus on gradual ventilator liberation, pulmonary hygiene, and preventing hospital readmissions. Inpatient rehabilitation centers employ RTs to help patients with COPD, spinal cord injuries, or neuromuscular diseases regain respiratory function.

Home Care and Outpatient Clinics

Home care RTs visit patients in their homes to set up and maintain oxygen concentrators, CPAP/BiPAP machines, and other durable medical equipment. They educate patients and families on disease self-management and equipment cleaning. Outpatient clinics specializing in asthma, sleep disorders, or pulmonary rehabilitation also hire RTs. Sleep labs employ RTs to perform overnight polysomnograms and score sleep data.

Specialized and Nontraditional Roles

With experience and advanced credentials, RTs can move into specialized niches:

  • Neonatal-pediatric transport teams: Accompanying critically ill infants or children between facilities
  • Flight respiratory therapy: Providing care in helicopters or fixed-wing aircraft
  • Pulmonary function lab management: Overseeing testing quality and regulatory compliance
  • Medical device sales and support: Working for companies that manufacture ventilators, monitoring systems, or airway devices
  • Clinical education: Teaching at respiratory therapy programs or hospital staff development
  • Healthcare administration or quality improvement: Managing budgets and developing clinical protocols

A bachelor's or master's degree is often required for leadership roles, but many RTs pursue these degrees while working.

Salary Expectations and Benefits

Respiratory therapy provides solid financial compensation. According to the U.S. Bureau of Labor Statistics (BLS), the median annual wage for respiratory therapists was $62,000 in May 2023. The top 10% of earners made over $89,000, while the bottom 10% earned less than $47,000. Factors that influence earnings include:

  • Geographic location: Higher salaries are common in the West and Northeast, especially in metropolitan areas
  • Experience level: RTs with 10+ years typically earn significantly more
  • Certification level: RRTs earn more than CRTs
  • Shift differentials: Night shifts, weekends, and holidays often add 10-20% to base pay
  • Specialty certifications: Holding NPS, ACCS, or SDS credentials can command premium pay

Benefits commonly include health insurance, retirement plans, paid time off, tuition reimbursement, and professional development funds. Many hospitals offer sign-on bonuses for experienced RTs, especially in areas with shortages.

Job Outlook and Career Stability

The job outlook for respiratory therapists is exceptionally strong. The BLS projects employment growth of 13% from 2022 to 2032, far exceeding the average for all occupations. Key drivers of this demand include:

  • Growing elderly population with higher rates of COPD, pneumonia, and lung cancer
  • Increasing incidence of chronic conditions like asthma and sleep apnea
  • Expanding use of advanced life-support technologies that require specialized operators
  • Heightened awareness of respiratory health following the COVID-19 pandemic
  • Shortages of RTs in many rural and underserved areas

This demand translates into job security and opportunities for overtime, travel contracts, and career advancement. Many hospitals offer tuition forgiveness or loan repayment programs to attract new graduates.

Continuing Education and Professional Growth

Maintaining Credentials and Licensure

Both NBRC credentials and state licenses require ongoing education. The RRT credential must be renewed every five years via the Continuing Competency Program (CCP). You can choose between earning 30 continuing education credits (CRCEs) or retaking the TMC and CSE exams. State licensure boards typically require 10-20 CEUs per year, which can overlap with NBRC requirements. The AARC provides a vast library of approved courses, webinars, and conferences to simplify compliance.

Advanced Specialty Certifications

Specializing within respiratory therapy can enhance your expertise, job satisfaction, and earning potential. The NBRC offers four advanced credentials:

  • Neonatal/Pediatric Respiratory Care Specialist (NPS): Focuses on the unique needs of infants and children
  • Adult Critical Care Specialist (ACCS): For RTs who want to master complex adult ICU care
  • Sleep Disorders Specialist (SDS): For those working in sleep medicine
  • Certified/Registered Pulmonary Function Technologist (CPFT/RPFT): For diagnostic testing specialists

Each requires passing a dedicated exam and usually a period of clinical experience. Many employers offer pay differentials for these certifications, often $1–$5 per hour extra.

Pathways to Leadership

Many RTs eventually transition into management, education, or research. Common leadership roles include:

  • Respiratory therapy manager/director: Overseeing staff schedules, budgets, quality improvement, and regulatory compliance
  • Clinical coordinator: Managing orientation and competency assessment for new hires
  • Program director or instructor: Teaching in a CoARC-accredited respiratory therapy program
  • Research coordinator: Assisting with clinical trials for new drugs, devices, or protocols

Pursuing a bachelor's or master's degree (e.g., in respiratory therapy, healthcare administration, or public health) opens these doors. Many programs are offered part-time online, making them feasible while working.

Getting Started Today: Your Action Plan

The path from aspiring student to certified respiratory therapist is clear and achievable. Here is a step-by-step checklist to begin:

  1. Research CoARC-accredited programs in your area or online that fit your schedule and budget.
  2. Complete all prerequisite coursework with strong grades. If needed, take refresher courses in math and science.
  3. Apply to multiple programs to increase your chances of acceptance.
  4. Secure financial aid: Complete the FAFSA, explore scholarships (e.g., from the AARC or local hospitals), and consider employer tuition assistance if you already work in healthcare.
  5. Enroll and engage fully: Participate in study groups, seek tutoring early, and build relationships with instructors and clinical preceptors.
  6. Prepare for NBRC exams throughout your last semester using practice tests and review resources.
  7. Take the TMC exam soon after graduation, then the CSE if you qualify.
  8. Apply for state licensure in the state where you plan to work.
  9. Start your job search: Use hospital career portals, professional networks, and job boards. Attend career fairs at your school.
  10. Continue learning: Pursue advanced certifications and continuing education to stay current and advance your career.

Respiratory therapy is a challenging, rewarding, and stable profession. With dedication to your education and clinical skills, you can make a tangible difference in patients' lives every day.