How to Become a Respiratory Therapist

By: Stephanie Curreli, MD, PhD

Last Updated: December 17, 2018

When a heart or lung problem strikes, respiratory therapists step in to help patients breathe easier. These professionals, also known as RTs, are experts in breathing therapies, treatments and emergency response. Respiratory therapists provide care and comfort to people with asthma, emphysema, chronic obstructive pulmonary disease (COPD), heart disease, premature birth and other medical conditions that affect the heart and lungs. They also respond to breathing-related emergencies due to drowning, heart attack or trauma.

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Respiratory therapists get the benefits of working in a growing field that demands their skills. Many enjoy the intellectual challenge of keeping up with new advances in science and technology. Best of all, they get the personal satisfaction of bringing comfort and relief to seriously ill patients who are struggling to breathe.

Workplace Details

Most RTs work in hospitals. Common settings include emergency departments, neonatal (newborn) units, intensive care units, pediatric units, and sleep labs. Nursing homes and home health services also employ a significant number of respiratory therapists, as do emergency medical transport services. An RT’s caseload can include patients of all ages, from premature babies to elderly people.

Most respiratory therapists work full time. Because their skills are needed around the clock, night, weekend, and holiday hours are the norm, especially for those employed by hospitals and other 24-7 healthcare facilities.

Respiratory therapy is a high-tech field, and the science of care is constantly changing. RTs work with laboratory equipment, including blood gas analyzers and spirometers. They also treat patients using nebulizers, oxygen tents, ventilators, monitoring equipment, and oxygen therapy systems.

In addition to technology, therapists spend a large percentage of their working hours with people. As part of a multidisciplinary health care team, they work with physicians, nurses, dietitians, social workers, and others to carry out a patient’s plan of care. They are generally supervised by the patient’s physician and in turn may supervise the work of respiratory therapy technicians.

Hover over any state to explore local income and job growth data.

According for the US Bureau of Labor Statistics, the median annual salary for respiratory therapists is $57,790, or $27.78 per hour. Salaries range from a median of $41,970 for the lowest-paid 10 percent to a median of $80,440 for the highest-paid 10 percent.

Salaries are highest for RTs working in outpatient facilities or at colleges, universities and professional schools (all of which generally require certification and a bachelor’s or master’s degree). Salaries also vary by geographic location. California currently pays the highest average wage.

According to the Bureau of Labor Statistics, employment of RTs is expected to grow by 12 percent between 2014 and 2024, which is faster than the average for all occupations. While there’s always been a need for excellent respiratory care, the RT profession has grown significantly in recent years. One reason for this growth is the aging of the US population. Older and middle-aged people are more susceptible to heart and lung conditions that require breathing treatments. Another reason for the growth of this profession is that the number of babies born prematurely has also been on the rise in recent years. Many “micro preemies” have underdeveloped lungs that require high-tech care. On top of these demographic trends, advances in science are creating new uses for respiratory therapy in patient care. Today, respiratory therapists treat more patients and types of conditions than ever before.

As a job hunter, you can increase your prospects by pursuing advanced certification (earning an RRT within a year of graduation is desirable). Holding a bachelor’s degree can also make you more competitive for entry-level jobs. It also helps to be flexible about location, because the need for respiratory therapists is greatest in rural areas.

The American Association of Respiratory Care (AARC) maintains an online career center where job seekers can learn what’s new in the field, view job openings, post resumes and more.

High school students considering a career in respiratory therapy can prepare by taking courses in health, biology, math, chemistry, and physics. Volunteer or shadowing experience in a health care setting is a great way to get a feel for the health professions.

It’s possible to become a licensed, certified respiratory therapist with an associate degree. Many employers prefer a bachelor’s degree, and supervisory and teaching positions may require a master’s.

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The National Board for Respiratory Care (NBRC), which oversees national certification, recognizes the following accrediting bodies for educational programs:

• Commission on Accreditation for Respiratory Care
• Commission on Accreditation of Allied Health Education Programs

Accredited programs can be found at colleges, universities, vocational/technical schools and the military. The NBRC maintains an online database of accredited programs. The AARC has developed a template to assist students in evaluating potential programs.

Respiratory therapy education covers anatomy and physiology, chemistry, physics, microbiology, pharmacology (medication science), math and CPR/life support certification. Students also complete supervised clinical rotations.

Aspiring respiratory therapists must complete a supervised clinical training program in which they learn to assess and diagnose patients and deliver common therapies and treatments. In addition, some advanced certifications in the field require work experience.

At present, practicing respiratory therapists must be licensed in all states except Alaska. Licensure typically requires fulfilling educational requirements and passing a knowledge exam. For the requirements near you, contact your state health board.

Certification as a respiratory therapist is voluntary but preferred by many employers. Many health care settings require newly hired respiratory therapists to earn their advanced credential, or RRT, within one year.

Credentialing for respiratory therapists is administered by the NBRC, which offers two certification levels:

• Certified Respiratory Therapist (CRT) is the entry-level credential. Candidates must hold an associate degree or higher from an accredited program and pass an exam covering clinical data, equipment and therapeutic procedures.
• Registered Respiratory Therapist (RRT) is the higher-level credential. Candidates must hold a CRT credential and pass clinical knowledge and paper-and-pencil “simulation” exams.

In the healthcare setting, experienced RTs can advance to the position of respiratory care manager. In this role, they oversee performance, scheduling, staffing, supervision, billing, and budgeting for the entire respiratory therapy department.

Some therapists also go on to work in the related area of case management, where they help to coordinate the care of people with chronic heart and lung disease. RTs who prefer to remain at the bedside can pursue specialty certification in sleep disorders, critical care or pediatric/neonatal care.

The public sector also offers opportunities for respiratory therapists. Community programs aimed at asthma management and smoking cessation often employ RTs. Teaching is another option for seasoned respiratory therapists. Those with advanced degrees can become professors, instructors or researchers at colleges or universities. An RT who supervises students during clinical rotations is known as a preceptor.

Respiratory therapists must hold, at minimum, an associate degree in order to practice in most states. These programs take about two years to complete (including a summer semester) and are offered through universities, community and technical colleges, vocational schools, and the armed forces.

The National Board for Respiratory Care is the sole certifying agency for respiratory therapy. It recognizes only one educational accreditor: the Commission on Accreditation for Respiratory Care (CoARC). When choosing an educational program, it’s crucial that you select one that’s CoARC accredited. CoARC maintains a searchable listing of programs on its website.

If you plan to continue your education beyond the associate degree level, look for a program with an articulation agreement. This means that the credits you earn as part of your associate degree can later be applied toward a bachelor’s degree at a four-year college in your area.

As an associate-level RT student, expect to study:

Employers increasingly prefer to hire respiratory therapists with four-year degrees. This pathway can also open doors to career advancement via management, research, and teaching.

There are about 50 CoARC-accredited RT bachelor’s degree programs in the United States. Most are located at universities and four-year colleges. Some two-year colleges also have articulation agreements with local universities, allowing their students to earn first an associate degree, then a bachelor’s without retaking any classes.

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Bachelor’s degree students learn the same RT clinical skills as their associate degree counterparts. However, they have more opportunity to explore their interests through general education classes. Studying business, psychology, sociology, and communications can help to improve critical thinking skills and enrich your future practice.

Students in bachelor’s-level RT programs often study:

Bachelor’s programs may also include certification in Basic Life Support, Advanced Cardiovascular Life Support, Pediatric Advanced Life Support, and neonatal resuscitation. Some also offer optional certificates in polysomnography (the study of sleep disorders).

In addition to the CRT and RRT certifications, The National Board for Respiratory Care (NRBC) also offers several advanced certifications for practicing therapists:

• Adult Critical Care Specialty (ACCS) - for RRTs working in the ICU with very sick patients who may be ventilated
• Pulmonary Function Technologist (CPFT and RPFT) - for therapists who have demonstrated competency in diagnostic testing for respiratory disorders. Two levels of certification are available: certified (basic) and registered (advanced).
• Neonatal/Pediatric Specialty (NPS) - this therapist has demonstrated the skills and knowledge needed to care for newborns, babies, children, and teens
• Sleep Disorders Specialty (SDS) - denotes competency in the diagnosis and treatment of sleep disorders like sleep apnea

To earn any of those advanced certifications, therapists must hold a CRT or RRT credential and pass an additional knowledge exam. Some credentials have additional requirements.

Respiratory therapists who have clinical experience treating sleep disorders may be eligible for certification by the Board of Registered Polysomnographic Technologists. Both entry-level and advanced credentials are available.

Most therapists also obtain certification in:

• Basic Life Support (BLS)
• Pediatric Advanced Life Support (PALS)
• Advanced Cardiovascular Life Support (ACLS)
• Neonatal Resuscitation Program (NRP)

These credentials are not specific to respiratory therapy, but are required by many employers and credentialing programs.