How to Become a Respiratory Therapist: The Complete Career Guide

Respiratory therapy is one of the most clinically rich, technically demanding, and personally rewarding careers in all of allied health — and one of the least understood by people outside the hospital. If you're considering it, you're probably asking the right questions: What does the path actually look like? What's the difference between the credentials? What does the work really involve day to day? And is the career trajectory worth the investment?

As a licensed Registered Respiratory Therapist with ICU and critical care experience and the owner of My Respiratory Company, I'll give you the honest, firsthand picture — not the recruiting brochure version.

What Respiratory Therapists Actually Do

Before committing to the education pathway, make sure you understand the scope of the work. Respiratory therapy is not a single-setting career. The clinical range is significant:

Managing mechanical ventilators for critically ill ICU patients — one of the most technically demanding bedside roles in medicine
Administering and monitoring inhaled medication therapy across all hospital units
Airway management, including intubation support and tracheostomy care
Pulmonary function testing and arterial blood gas analysis
Neonatal and pediatric respiratory care in NICUs and PICUs
Sleep studies and CPAP titration in sleep labs
Home care and DME management for patients on home oxygen, CPAP, and ventilators
Pulmonary rehabilitation program delivery

For a complete breakdown of everything this profession covers, see our detailed guide on what a respiratory therapist does.

The Educational Pathway

Step 1: Accredited Respiratory Therapy Program

The foundational requirement is completing a respiratory therapy program accredited by the Commission on Accreditation for Respiratory Care (CoARC). There are two degree levels:

Associate Degree (2 Years)

The minimum educational requirement for entry into the profession. Most community colleges and some four-year institutions offer CoARC-accredited associate degree programs in respiratory therapy. The curriculum covers cardiopulmonary anatomy and physiology, respiratory pharmacology, mechanical ventilation, airway management, pulmonary diagnostics, neonatal and pediatric care, and clinical rotations across hospital settings.

An associate degree qualifies you to sit for the national credentialing exams. The majority of working respiratory therapists entered the profession with an associate degree, though this is gradually shifting.

Bachelor of Science in Respiratory Therapy (4 Years)

A growing number of programs now offer or require a bachelor's degree pathway. Some institutions offer a completion pathway for RTs who already hold an associate degree and want to advance to a BSc. A bachelor's degree opens additional doors: leadership and management roles, educator positions, some research opportunities, and increasingly, admission to advanced practice programs.

The 2015 AARC Human Resources Study projected that a bachelor's degree would become the standard entry-level requirement for the profession. That transition is underway but not yet universal — the associate degree pathway remains viable in most states, though new graduates with bachelor's degrees may have competitive advantages in some hiring markets.

Step 2: The NBRC Credentialing Exams

The National Board for Respiratory Care (NBRC) administers the credentialing exams that determine your professional credential level. There are two sequential credential levels:

CRT — Certified Respiratory Therapist

The entry-level credential. Requires passing the Therapist Multiple-Choice (TMC) examination at the entry-level cut score. The TMC tests knowledge across the full scope of respiratory therapy practice — patient assessment, equipment, therapeutic procedures, emergency care, and disease management.

Most states require at minimum a CRT license to practice as a respiratory therapist. Some states accept CRT as the licensure basis; others require the advanced RRT credential for full licensure.

RRT — Registered Respiratory Therapist

The advanced credential and the standard of practice in most ICU, critical care, and specialist settings. Requires:

Passing the TMC examination at the advanced cut score (a higher threshold than the entry-level score on the same exam)
Passing the Clinical Simulation Examination (CSE) — a case-based exam that presents branching clinical scenarios testing decision-making in complex cardiopulmonary situations

The RRT is not optional for serious clinical practice. ICU, critical care transport, neonatal, and sleep medicine positions almost universally require or prefer it. If your goal is to work in high-acuity settings, plan to achieve the RRT before or immediately after entering the job market.

Step 3: State Licensure

Respiratory therapy is a licensed profession in most US states, though licensure requirements vary. After passing the appropriate NBRC exam(s), you apply for state licensure in the state(s) where you plan to practice. Most states require continuing education (typically 12–24 hours per license renewal cycle) to maintain active licensure.

Check the specific requirements for your state through the NBRC or your state's health professional licensing board — a small number of states do not currently require licensure, though this is becoming less common as more states adopt licensure requirements.

Specialty Credentials: Going Beyond the RRT

The NBRC offers specialty credentials for RTs who develop advanced expertise in specific clinical areas:

Credential	Full Name	Clinical Focus
RRT-NPS	Neonatal/Pediatric Specialist	NICU, PICU, pediatric airway and ventilation
RRT-SDS	Sleep Disorders Specialist	Polysomnography, CPAP titration, sleep lab
RRT-ACCS	Adult Critical Care Specialist	ICU ventilator management, critical care protocols
CPFT / RPFT	Certified/Registered Pulmonary Function Technologist	Spirometry, lung volumes, DLCO, pulmonary diagnostics

Specialty credentials are not required for most positions but distinguish candidates in competitive hiring markets and often correlate with higher compensation. The RRT-ACCS is increasingly valued in high-acuity ICU environments; the RRT-SDS is relevant if you're interested in sleep medicine and CPAP management, which is directly applicable to home care and DME work like what My Respiratory Company provides.

What the Clinical Training Actually Looks Like

Respiratory therapy programs integrate substantial clinical rotations alongside didactic coursework. Clinical sites typically include:

Medical and surgical ICUs
Emergency departments
General medical-surgical floors
Neonatal and pediatric units (usually in final-year rotations)
Pulmonary function labs
Sleep labs (some programs)
Cardiac care units

The clinical hours are where respiratory therapy education separates from textbook knowledge. Mechanical ventilator management, arterial line blood draws, intubation assistance, and neonatal care cannot be fully learned outside a clinical environment. Programs that place students in high-acuity settings with strong clinical preceptors produce graduates who are meaningfully better prepared than those with limited ICU exposure.

When evaluating programs, ask specifically about ICU clinical placement, NICU exposure, and the ratio of simulation to actual patient contact hours. These questions distinguish programs more than brochure comparisons do.

Job Market and Compensation

Respiratory therapy has one of the stronger job market outlooks in allied health. The aging US population, rising COPD prevalence, increasing recognition of sleep apnea as a major public health issue, and growth in home-based and telehealth respiratory care are all structural drivers of demand.

The Bureau of Labor Statistics (BLS) consistently projects above-average job growth for respiratory therapists. Hospital RT positions remain the largest employment category, but home care, DME, pulmonary rehabilitation, and private practice settings are growing as the delivery of respiratory care moves increasingly toward outpatient and home-based models.

Compensation varies significantly by setting, geography, shift differential, and credential level:

Entry-level CRT (general floor): $45,000–60,000/year in most markets
RRT (general hospital): $55,000–75,000/year
RRT (ICU/critical care): $65,000–90,000/year, higher in high-cost-of-living markets
Travel RT: $90,000–$130,000+ in high-demand markets (contracts vary widely)
Home care / DME / private practice: Variable; often lower base salary than hospital but different lifestyle tradeoffs

Night shift differentials (typically 10–20% additional), weekend differentials, and overtime significantly increase total compensation for hospital-based RTs willing to work non-standard hours.

The Private Practice and DME Dimension

An increasingly relevant career path for RTs is outpatient and DME-based practice — providing clinical expertise in CPAP therapy management, home oxygen oversight, pulmonary rehabilitation consultation, and respiratory telehealth. This is the model behind My Respiratory Company: an RRT-owned DME that brings clinical depth to equipment decisions and therapy management that traditional retail DME cannot provide.

For RTs interested in entrepreneurship, the intersection of clinical expertise and DME business ownership is a high-value opportunity. The credential differentiates a clinician-owned DME from a pure equipment retailer in ways that matter to patients managing chronic conditions — COPD, sleep apnea, bronchiectasis, neuromuscular disease — who benefit from ongoing clinical oversight rather than a one-time equipment transaction.

See our guide on what respiratory therapists do for the full scope of practice that makes this model viable.

Is Respiratory Therapy Right for You?

The people who thrive in respiratory therapy tend to share a few characteristics:

Comfort with technical complexity: Mechanical ventilators, arterial blood gases, pulmonary function data, and pharmacology are daily work. This is a technically demanding profession that rewards people who enjoy mastering complex systems.
High-stakes composure: Airway emergencies, ventilator alarms, and rapid patient deterioration are part of the ICU landscape. Staying clear-headed under acute pressure is not a trainable skill for everyone — be honest with yourself about whether that environment energizes or overwhelms you.
Physical and schedule resilience: Most hospital RT positions involve 12-hour shifts, night and weekend rotation, and significant time on your feet. The physical demands are real.
Long-term intellectual engagement: Respiratory therapy involves continuous learning — new ventilator modes, evolving clinical protocols, emerging pharmacology. The field doesn't stand still, and neither do the practitioners who stay relevant in it.

If those characteristics resonate, respiratory therapy offers a career with genuine clinical depth, strong job security, meaningful patient impact, and a scope of practice that continues to expand as the profession matures.

Frequently Asked Questions

How long does it take to become a respiratory therapist?

An associate degree pathway typically takes 2 years for full-time students; some accelerated programs complete in 18 months. A bachelor's degree takes 4 years (or 1–2 additional years as a completion program for existing RTs with associate degrees). After graduation, the NBRC credentialing exams and state licensure add 1–3 months. Most students complete the associate degree pathway and are working as credentialed RTs within 2–2.5 years of starting the program.

Do I need a bachelor's degree to become a respiratory therapist?

Currently, no — an accredited associate degree program satisfies the educational requirement for NBRC credentialing and most state licensure in most states. However, the profession is moving toward a bachelor's degree standard, and some employers and specialty positions already prefer or require it. If you're starting from scratch with a long career ahead, a bachelor's degree pathway is worth serious consideration for its long-term career flexibility.

What's the difference between a CRT and an RRT?

Both credentials are awarded by the NBRC after passing the TMC exam. The CRT is awarded at the entry-level TMC cut score and does not require the Clinical Simulation Exam. The RRT requires the advanced TMC cut score plus passing the CSE. The RRT is the standard advanced credential required for most ICU and specialist positions. Plan to achieve the RRT.

Is respiratory therapy school hard?

It's challenging, particularly for students without a strong science background coming in. Anatomy, physiology, pharmacology, and the mechanical and mathematical dimensions of ventilator management require genuine study investment. Clinical rotations add a separate layer of intensity. Students who enter with biology and chemistry preparation, strong study habits, and a clear motivation for the work do well. Students who underestimate the academic rigor or treat it casually tend to struggle with board exam pass rates.

Can respiratory therapists work independently or own their own practice?

Yes — RTs can operate in private practice, DME ownership, telehealth, consulting, and education. Scope of practice varies by state; some states permit independent RT practice, others require physician supervision for certain functions. DME ownership is the most common entrepreneurial path for RTs, as it directly applies clinical expertise to equipment management and patient support in a business model that doesn't require physician oversight for equipment provision and therapy consultation. My Respiratory Company is a direct example of this model.

The Bottom Line

Respiratory therapy is a technically demanding, clinically meaningful, and financially viable career with strong long-term demand drivers. The path — accredited program, NBRC credentialing, state licensure — is clear and achievable in 2–2.5 years for associate degree graduates. The RRT credential is the target, not the ceiling. Specialty credentials and continued learning open progressively specialized and compensated career paths from there.

If you're drawn to the cardiopulmonary system, to critical care environments, to the technical complexity of ventilator management or sleep medicine, and to a profession where your expertise directly protects and sustains life — this is a career worth pursuing seriously.

For the patient-facing side of what respiratory therapy expertise looks like in practice, browse our clinical blog — from CPAP troubleshooting to COPD breathing exercises to what RTs do in clinical settings. And if you need respiratory equipment or clinical consultation, browse our catalog or book a $49.99 RT Consultation with a licensed RRT.

Written by Yashil Bhatt, RRT — Licensed Registered Respiratory Therapist with ICU and critical care experience and owner of My Respiratory Company.