Respiratory Therapist Career Guide: What RTs Do and How to Become One
Respiratory therapists are the clinicians hospitals call when breathing becomes the problem that cannot wait. They assess cardiopulmonary conditions, deliver treatments, manage ventilators, support artificial airways, perform diagnostic tests, and teach patients and caregivers to use respiratory equipment.
Their patients range from premature infants with underdeveloped lungs to older adults with chronic obstructive pulmonary disease (COPD). The career can provide a relatively direct route into critical care, but that access comes with nights, weekends, infection exposure, physical work, and regular contact with severe illness and death.
Respiratory therapist career at a glance
| Career factor | Current U.S. picture |
|---|---|
| Typical entry-level education | Associate degree |
| Program accreditation | Choose an entry-to-practice program accredited or supported by the Commission on Accreditation for Respiratory Care (CoARC) |
| National credentials | Certified Respiratory Therapist (CRT) and Registered Respiratory Therapist (RRT), awarded by the National Board for Respiratory Care (NBRC) |
| State authorization | Every state has enacted RT licensure; requirements, effective dates, and implementation processes vary |
| Largest employer | Hospitals, which accounted for about 80 percent of jobs in 2024 |
Bottom line: Respiratory therapy can fit people who want specialized, hands-on patient care and can stay calm around unstable airways, alarms, bodily fluids, grieving families, and rapidly changing clinical information. It is a poor fit for someone who needs predictable weekday hours, dislikes close patient contact, or wants the broad specialty mobility available in nursing.
What does a respiratory therapist do?
Respiratory therapists focus on breathing and cardiopulmonary function. Exact duties depend on state law, employer policies, the clinical setting, and the therapist’s training and credentials.
Common responsibilities include:
- Interviewing and assessing patients with breathing or cardiopulmonary problems
- Measuring oxygen and carbon dioxide levels, including through arterial blood gas testing where permitted
- Performing pulmonary function tests such as spirometry
- Delivering oxygen, aerosol medications, airway-clearance treatments, and other respiratory therapies
- Setting up, monitoring, and adjusting invasive and noninvasive ventilation
- Monitoring artificial airways and assisting with airway procedures
- Responding to rapid responses, trauma cases, and cardiopulmonary arrests
- Helping determine whether a patient is ready to be weaned from a ventilator
- Teaching patients and families to use inhalers, oxygen systems, CPAP or BiPAP devices, and home ventilators
- Documenting care and communicating changes to physicians, nurses, and other clinicians
Where respiratory therapists work
The setting changes almost everything: pace, schedule, patient acuity, autonomy, physical strain, and emotional load.
Adult ICU and emergency care
Ventilator management, noninvasive ventilation, airway support, blood gas analysis, emergency response, and ventilator weaning.
Reality: High acuity, frequent interruptions, and common night, weekend, holiday, or 12-hour shifts.
NICU and PICU
Specialized respiratory support for premature infants, children, and critically ill pediatric patients.
Reality: Small airways, narrow margins for error, and emotionally intense communication with families.
Pulmonary function laboratory
Spirometry, lung-volume testing, diffusion studies, equipment quality control, and patient coaching.
Reality: More scheduled outpatient work, but reliable results demand calibration, repeatable technique, and genuine patient effort.
Sleep laboratory
Overnight monitoring, study documentation, and positive-airway-pressure titration for sleep disorders.
Reality: Often quiet and independent, but nocturnal. Separate sleep experience, education, or credentials may be expected.
Home care and equipment services
Oxygen and ventilator setup, equipment troubleshooting, safety checks, and caregiver education.
Reality: More travel and autonomy, with possible on-call coverage and equipment problems outside a controlled hospital.
Rehabilitation and long-term care
Monitored exercise, chronic-disease education, tracheostomy care, ventilation support, and readmission prevention.
Reality: More relationship-based care, although long-term acute-care and skilled-nursing workloads can still be demanding.
Critical care
In an ICU or emergency department, an RT may move from a deteriorating COPD patient to a trauma airway and then to a ventilated patient whose blood gases have changed. The work rewards fast pattern recognition, technical competence, and calm communication.
It also carries the profession’s sharpest edges. RTs may help turn or transport patients, move equipment, enter isolation rooms, and participate when life support is withdrawn. The work can be deeply meaningful. It can also be exhausting.
Neonatal and pediatric care
NICU and PICU respiratory therapists may manage specialized ventilation, support surfactant delivery, and help care for infants or children with respiratory failure. Clinical precision matters, but so does explaining frightening situations to families without becoming cold or vague. Therapists in this area may pursue the NBRC’s Neonatal/Pediatric Specialist credential after earning the RRT.
Diagnostics, sleep, and home care
Pulmonary diagnostics can suit people who enjoy physiology and testing but prefer a more scheduled environment than bedside critical care. Sleep work combines respiratory monitoring with neurophysiology, although an RT credential alone does not qualify someone for every sleep-technologist role.
Home-care RTs teach patients and caregivers to use oxygen systems, positive-airway-pressure devices, or home ventilators safely. A technically perfect explanation is useless if the patient cannot follow it after the therapist leaves.
Is respiratory therapy a good career?
It can be. The strongest arguments are relatively short entry-level education, specialized clinical responsibility, solid national pay, and faster-than-average projected growth. But a salary chart cannot tell you whether you will tolerate suctioning an airway at 3 a.m., enjoy troubleshooting ventilator waveforms, or carry an end-of-life case home in your head.
Respiratory therapy may suit you if:
- You want direct patient care while specializing in one physiological system
- You can think clearly while alarms are sounding
- Anatomy, physiology, pharmacology, and applied science interest you
- You like equipment, measurements, and immediate feedback
- You can communicate with scared patients and families
- You are willing to work clinical shifts while building experience
Think twice if:
- You need weekday daytime hours immediately after graduation
- You strongly dislike bodily fluids, infection exposure, or close physical contact
- You want the breadth of specialties available to registered nurses
- Physiology and technical troubleshooting make you miserable
- You freeze during emergencies or personalize every bad outcome
- You expect an online-only program to prepare you for hands-on practice
You do not need to be an adrenaline addict. Pulmonary function, rehabilitation, education, sleep medicine, management, and home care offer different rhythms. Still, most new graduates should expect clinical training and early job opportunities to involve real bedside care.
How to become a respiratory therapist
The usual pathway has four gates: education, clinical training, national credentialing, and state authorization.
Choose an eligible program
Prioritize an entry-to-practice program accredited or supported by CoARC that leads to at least an associate degree and supports the applicable NBRC examination route.
Complete labs and clinicals
Build skills in classrooms and simulation labs, then apply them during supervised clinical rotations with real patients and care teams.
Earn an NBRC credential
Qualify for and pass the applicable NBRC examination standard to earn the CRT or RRT. The examination structure changes in January 2027.
Obtain state authorization
Apply through the relevant state process. Education, exam, background-check, fee, renewal, and scope rules can vary.
1. Complete prerequisites and choose the right program
Respiratory therapy programs commonly require or include anatomy and physiology, microbiology, chemistry, algebra, pharmacology, cardiopulmonary pathophysiology, and respiratory-care procedures.
A bachelor’s degree may improve access to leadership, education, research, sales, or future graduate study, but it is not the typical national entry-level requirement. Before enrolling, verify:
- The program’s current CoARC status and exact degree awarded
- Whether the school arranges every clinical placement
- Clinical-site locations, travel requirements, and possible shift times
- Recent retention, job-placement, and credentialing outcomes
- Whether exam pass rates mean first attempts or eventual success
- Total tuition, fees, and costs for uniforms, screening, immunizations, equipment, parking, travel, exams, and licensing
CoARC publishes comparable program outcomes. Use them. A shiny simulation manikin is not a substitute for retention and credentialing data.
Learn how programmatic and institutional accreditation differ.
2. Complete laboratory and supervised clinical training
Students first build skills in classrooms and simulation labs, then apply them during supervised clinical rotations. Experiences may include general floors, emergency care, adult critical care, neonatal or pediatric care, pulmonary diagnostics, and other settings available through the program.
Clinical education is not an optional internship bolted onto an online course. It is where students learn to assess actual patients, operate equipment safely, communicate with clinical teams, and perform under observation.
Ask what happens if a clinical site becomes unavailable and whether students commonly reduce outside work during clinical terms. Unpaid clinical hours, commuting, and irregular schedules can create a bigger financial problem than textbooks.
3. Earn an NBRC credential
The NBRC awards the national CRT and RRT credentials. It does not issue state licenses. In 2026, the legacy route uses the Therapist Multiple-Choice Examination (TMC) and, for candidates who reach its higher cut score, the Clinical Simulation Examination (CSE) to earn the RRT.
Beginning in January 2027, the NBRC plans to replace that route with one Respiratory Therapy Examination containing 185 multiple-choice items: 160 scored and 25 pretest. The four-hour exam will use two cut scores. Meeting the lower cut score earns the CRT; meeting the higher cut score earns the RRT. NBRC has announced a $360 new-applicant fee and a $300 repeat-applicant fee.
4. Obtain state authorization to practice
Credentialing and licensing are different. An NBRC credential demonstrates that a person met a national examination standard. A state license or equivalent authorization gives legal permission to practice in that jurisdiction.
In June 2026, Alaska became the 50th state to enact respiratory therapist licensure. Alaska’s implementation details and timeline were still being developed when this guide was published. Verify the current process directly with the state responsible for the location where you intend to work.
Do not assume a credential or license transfers automatically when you move. The Respiratory Care Interstate Compact reached the enactment threshold required to begin implementation in 2026, but usable compact privileges depend on participating states, commission rules, and operational systems.
CRT vs. RRT and the 2027 examination change
CRT and RRT are national credentials, not separate college degrees. The RRT represents the higher examination standard and is widely preferred or required for acute-care jobs and advancement.
| Question | CRT | RRT |
|---|---|---|
| Awarded by | NBRC | NBRC |
| Current 2026 route | Pass the TMC at the lower cut score | Reach the TMC high cut score and pass the CSE |
| Planned 2027 route | Reach the lower cut score on the new Respiratory Therapy Examination | Reach the higher cut score on the same examination |
| Employment position | Valid entry-level credential; opportunities may be more limited | Widely preferred in acute care and for advancement |
| State authorization | Still required under the applicable state process | Still required under the applicable state process |
Important credential-transition dates
The expiring CRT-to-Registry policy mainly affects certain existing CRTs who do not have the education required for the new examination pathway. Current students should follow NBRC candidate guidance and their program director instead of reverse-engineering an old route from forum posts.
Respiratory therapist salary and job outlook
The May 2025 Occupational Employment and Wage Statistics estimate for respiratory therapists shows:
- Median annual wage: $82,280
- Median hourly wage: $39.56
- Average annual wage: $87,300
- Lowest-paid 10 percent: $63,660 or less
- Highest-paid 10 percent: $118,050 or more
- Estimated U.S. employment: 139,790
These are national occupation-wide estimates, not promised starting salaries. Pay varies with location, employer, shift differential, experience, overtime, union coverage, and job setting. Federal wage data does not establish a guaranteed premium for holding the RRT, ACCS, NPS, SDS, or pulmonary-function credentials.
BLS projects employment to rise from about 139,600 jobs in 2024 to 156,400 in 2034. That equals roughly 12 percent growth, or 16,800 additional jobs. BLS also projects about 8,800 openings per year, including openings created when workers leave the occupation or labor force.
An aging population and respiratory disease prevalence are expected to support demand. Hospitals will remain central, while efforts to prevent readmissions may support work in clinics, physician offices, rehabilitation, and home-based care.
Physical demands, stress, and schedules
Hospital respiratory therapy is not a clean little equipment job conducted from the foot of the bed. RTs may:
- Stand and walk for much of a shift
- Lift or turn patients with a care team
- Move ventilators, oxygen cylinders, and other equipment
- Wear protective equipment and enter isolation rooms
- Work nights, weekends, holidays, and rotating shifts
- Respond to multiple urgent requests
- Treat patients with infectious diseases
- Witness trauma, unsuccessful resuscitations, and withdrawal of life support
The pressure is not identical everywhere. A pulmonary function lab may offer scheduled appointments and lower physical strain. Sleep work is predictable but nocturnal. Home care replaces hospital chaos with driving, self-reliance, and equipment problems in uncontrolled environments.
Before accepting a job, ask about orientation length, staffing, assignments, overtime, on-call requirements, equipment support, and whether new graduates receive structured mentoring.
Respiratory therapist vs. nurse and related careers
| Career | Primary focus | Typical entry-level education | Work-style distinction |
|---|---|---|---|
| Respiratory therapist | Airway, breathing, ventilation, oxygenation, and cardiopulmonary testing | Associate degree | Deep specialization in cardiopulmonary care |
| Registered nurse | Whole-patient assessment, medication administration, coordination, and broad clinical management | Bachelor’s degree is listed by BLS as typical, although U.S. pathways vary | Much broader specialty and setting mobility |
| Paramedic | Emergency assessment and stabilization before or during transport | Postsecondary nondegree award is typical; requirements vary | Short-duration care in uncontrolled field environments |
| Cardiovascular technologist | Cardiac imaging, testing, monitoring, or invasive cardiovascular procedures | Associate degree is typical | Greater focus on the heart and vascular system than ventilation |
| Pulmonary function technologist | Diagnostic measurement of lung mechanics and gas exchange | Requirements vary | More scheduled diagnostic work and less bedside critical care |
Respiratory therapist vs. nurse
RTs specialize more narrowly. In an ICU, an RT may concentrate on the airway, ventilator, oxygenation, and blood gases while a nurse manages medications, lines, assessments, documentation, and the broader care plan.
Nursing programs can lead to much broader clinical mobility. Respiratory therapy can provide earlier concentration in critical cardiopulmonary care. Neither role is simply a better version of the other.
Respiratory therapist vs. paramedic
Paramedics stabilize patients in homes, streets, ambulances, and other uncontrolled environments. RTs generally provide ongoing cardiopulmonary care in facilities with laboratory, imaging, and multidisciplinary support.
Paramedic experience can be useful preparation, but it does not replace respiratory therapy education, credentialing, or licensing. Compare EMT and paramedic training options.
Respiratory therapist vs. cardiovascular technologist
Both careers use physiology, monitoring equipment, and patient interaction, but their center of gravity differs. Respiratory therapy focuses on ventilation and oxygenation. Cardiovascular technology focuses more heavily on cardiac or vascular imaging, diagnostic testing, monitoring, or invasive procedures. Explore cardiovascular technology programs.
Specialty credentials and advancement
After earning the base credential and gaining applicable experience, RTs can pursue specialty credentials or move into education, management, quality improvement, research, clinical applications, medical-device support, or sales.
| NBRC specialty credential | Focus | Current eligibility note |
|---|---|---|
| Adult Critical Care Specialist (ACCS) | Advanced adult critical care | Requires the RRT credential for at least one year before applying |
| Neonatal/Pediatric Specialist (NPS) | Neonatal and pediatric respiratory care | Requires the RRT credential |
| Pulmonary Function Technology (CPFT/RPFT) | Pulmonary diagnostic testing | One exam uses two cut scores; several education or credential routes can establish eligibility |
| Sleep Disorders Specialist (SDS) | Sleep testing and treatment | Requires an eligible CRT or RRT route plus the applicable education or waiting period |
Specialty credentials can demonstrate expertise, but they do not automatically expand legal scope or guarantee higher pay. Employer privileging, state law, and actual competency still control what someone may do.
What about advanced practice respiratory therapists?
Advanced Practice Respiratory Therapist (APRT) is an emerging graduate-level model, not a universal next rung available in every state and hospital. CoARC accredits advanced-practice respiratory care programs, while advocates continue to pursue legislation and role development.
Treat APRT as a developing pathway. Do not enroll in respiratory therapy assuming it already offers the same nationwide advanced-practice route as nursing.
RTs may also complete separate education to become physician assistants, perfusionists, nurses, educators, or healthcare managers. Their clinical background may help, but it does not waive the new profession’s admission, degree, certification, or licensing requirements.
Will AI or automated ventilators replace respiratory therapists?
Automation will change parts of the job. Ventilators can support closed-loop adjustments, decision-support systems can flag patterns, and remote monitoring can help teams track patients outside hospitals.
That is different from replacing the clinician responsible for:
- Deciding whether a machine’s recommendation fits the whole patient
- Managing an unstable or obstructed airway
- Responding when equipment, anatomy, and protocol do not line up neatly
- Coordinating care with physicians and nurses
- Teaching a family to manage respiratory equipment at home
- Communicating during frightening or ethically difficult decisions
The more likely future is greater automation around monitoring and routine adjustment, with RTs expected to understand increasingly complex equipment and exercise stronger clinical judgment. Anyone who hates learning new technology should notice the warning label.
Questions to ask respiratory therapy schools
- Is this specific program currently accredited or supported by CoARC for entry into professional practice?
- What degree will I receive, and which NBRC examination route will I qualify for at graduation?
- What are the latest retention, job-placement, and RRT credentialing-success rates?
- Do published exam results show first-attempt rates or eventual pass rates?
- Who arranges clinical placements, and can I be sent far from campus?
- What shifts can clinical rotations require?
- What happens if I cannot attend a particular clinical site or schedule?
- What is the full estimated cost, including prerequisites, fees, uniforms, screening, travel, parking, exams, and licensing?
- How does the curriculum prepare students for the 2027 NBRC examination?
- How much simulation and direct clinical experience will I complete?
- What tutoring or remediation is available before a student falls behind?
- Which employers hire recent graduates, and do they require the RRT at hire?
If a school cannot answer those questions without retreating into brochure fog, keep shopping.
Frequently asked questions
How long does it take to become a respiratory therapist?
An associate degree commonly takes about two years after prerequisites, while a bachelor’s degree usually takes about four. The real timeline may be longer if admission is competitive, prerequisites are separate, courses run in sequence, or licensing is delayed after graduation.
Is respiratory therapy school hard?
It can be academically and logistically demanding. Students study anatomy, physiology, pharmacology, cardiopulmonary disease, gas behavior, mechanical ventilation, and patient assessment while completing laboratories and supervised clinical rotations.
Can respiratory therapy training be completed online?
Some programs deliver academic coursework online or in a hybrid format. Entry-level preparation still requires hands-on laboratory and supervised clinical education. Verify who arranges those experiences and whether the program supports NBRC-exam and state-licensing eligibility.
Do respiratory therapists intubate patients?
Some do, depending on state scope of practice, facility policy, approved protocols, privileging, training, and the clinical situation. It is not a universal duty for every RT.
Do respiratory therapists need a bachelor’s degree?
Not usually for entry-level practice. BLS lists an associate degree as the typical entry-level education, although some employers prefer a bachelor’s degree and advanced roles may require more education.
Is RRT better than CRT?
RRT represents the higher NBRC examination standard and is widely preferred in acute care. CRT remains a valid credential, but job options or advancement may be more limited. Neither credential replaces state authorization to practice.
Can a respiratory therapist become a nurse or physician assistant?
Yes, but the person must complete the required education, clinical training, examinations, and licensing for the new profession. Respiratory therapy experience may strengthen an application; it is not a shortcut around formal requirements.
Do respiratory therapists work only in hospitals?
No. Hospitals employ most RTs, but opportunities also exist in pulmonary function labs, physician offices, sleep labs, rehabilitation programs, home-care organizations, skilled nursing facilities, education, management, and medical-equipment roles.
Sources and methodology
Sources and federal datasets reviewed July 29, 2026.
Wage figures use the U.S. Bureau of Labor Statistics May 2025 Occupational Employment and Wage Statistics national estimate for Respiratory Therapists (SOC 29-1126). Outlook figures use BLS 2024–2034 Employment Projections and the Occupational Outlook Handbook. Because the datasets have different reference periods, their employment estimates do not match exactly.
- U.S. Bureau of Labor Statistics: Respiratory Therapists, Occupational Outlook Handbook
- U.S. Bureau of Labor Statistics: Occupational Employment and Wage Statistics
- National Board for Respiratory Care: Examination Changes Coming in 2027
- National Board for Respiratory Care: CRT-to-Registry Admission Policy Expiration
- National Board for Respiratory Care: ACCS examination requirements, NPS examination requirements, PFT examination requirements, and SDS examination requirements
- Commission on Accreditation for Respiratory Care: Find an Accredited Program and Programmatic Outcomes Data
- American Association for Respiratory Care: Alaska Becomes the 50th State to License Respiratory Therapists
- American Association for Respiratory Care: Respiratory Care Interstate Compact Reaches Its Activation Milestone
Explore respiratory therapy training
Compare respiratory therapist programs, degree options, and school locations. Before requesting information, keep the accreditation, clinical-placement, outcomes, and total-cost questions from this guide handy.
