How to become a respiratory therapist

1. 1Take science and math in high school

   Time: 4 years (high school)Sources 1

   Biology, chemistry, physics and algebra are the courses BLS points to, and respiratory programs build on all four: gas laws, acid-base balance and lung mechanics come up in the first semester. Anatomy or health science classes help too. Ask a local hospital about volunteering or a job-shadow day in the respiratory department, which shows you what ICU and emergency work looks like before you commit to a program.

2. 2Finish prerequisites and choose a CoARC-accredited program

   Time: One semester to 1 yearCost: Community college tuitionSources 3, 1

   Many programs require college courses such as anatomy and physiology, microbiology, chemistry and math before you start the respiratory courses. Check accreditation first: CoARC is the only national accreditor for respiratory care programs, and only graduates of CoARC-accredited programs can take the NBRC exams. CoARC's online search lists accredited programs by state, at associate, bachelor's and master's levels. Admission to some programs is competitive because clinical spots are limited.

3. 3Complete the respiratory care program

   Time: 2 years (associate) or 4 years (bachelor's)Cost: $4,650/yr median public in-state tuition (associate)Sources 1, 3, 5

   Coursework covers cardiopulmonary anatomy and physiology, pharmacology, blood gas interpretation, ventilator management, neonatal and pediatric care, and pulmonary diagnostics. You practice on manikins and simulators in the lab, then rotate through hospital floors, ICUs, emergency departments and neonatal units under supervision. Clinical rotations often follow hospital shift hours, including early mornings, so a full-time job alongside the program is difficult.

4. 4Pass the TMC exam to earn the CRT

   Time: Soon after graduationCost: $190Sources 2

   The Therapist Multiple-Choice Examination has 160 questions (140 scored) and a 3-hour limit. It has two cut scores: passing the lower one earns the Certified Respiratory Therapist (CRT) credential, while reaching the higher one also makes you eligible for the Clinical Simulation Examination. You must be at least 18 and a graduate of a CoARC-accredited program to apply. You can take it up to three times before a 120-day wait applies.

5. 5Pass the Clinical Simulation Exam to earn the RRT

   Time: Weeks to a few months after the TMCCost: $200Sources 2, 4

   The CSE presents 22 patient scenarios (20 scored) over 4 hours, testing how you gather information and make treatment decisions as a case unfolds. Passing earns the Registered Respiratory Therapist (RRT) credential. Several states, including California, Ohio, Arizona, Oregon, New Mexico, Georgia, Washington and West Virginia, now require the RRT for a new license, Missouri joins them on January 1, 2027, and many hospitals elsewhere hire only RRTs or require it within a set time.

6. 6Apply for your state license

   Time: 1-2 monthsCost: State license feeSources 1, 7, 6

   Every state except Alaska licenses respiratory therapists. Send your NBRC credential verification, transcript, application and fee to the state board, and complete any background check or law exam it requires. Rules differ, so look up your state in the CareerOneStop License Finder before you apply for jobs. Once licensed, plan for license renewal with continuing education and NBRC credential maintenance on a five-year cycle.

7. 7Optional: earn a specialty credential

   Time: After gaining experience as an RRTCost: $250-$300 per examSources 8

   RRTs can add NBRC specialty credentials. The Neonatal/Pediatric Specialty (NPS) exam is open only to RRTs and costs $250 for new applicants; the Adult Critical Care Specialty (ACCS) exam costs $300 and requires at least one year as an RRT. Other NBRC specialties cover sleep disorders and pulmonary function testing. These credentials help with jobs in NICUs, pediatric hospitals, transport teams and adult ICUs.

Programs, tuition and graduates’ earnings

U.S. Department of Education, College Scorecard (most recent cohorts, released 2026-10-15). Scorecard groups programs by 4-digit field, so a row can include related programs. Tuition is the median published undergraduate tuition and fees of the colleges offering the program (shown only for undergraduate credentials); debt is the median of programs’ median federal loan debt at completion; earnings are the national median for the field and credential four years after completion.

Requirements differ by state. Check your state’s rules in the CareerOneStop License Finder (U.S. Department of Labor) before you enroll.

Calm under pressure

RTs are called to codes and crashing patients, where a secure airway and correct ventilator settings are needed within minutes.

Reading blood gases and monitors

Ventilator changes depend on correctly interpreting pH, oxygen and carbon dioxide values alongside the patient's breathing pattern.

Equipment know-how

Ventilators, high-flow systems and BiPAP machines must be set up, checked and fixed quickly, often at the bedside.

Attention to detail

A wrong oxygen setting or missed alarm can harm a patient, so RTs track settings and responses carefully in the chart.

Patient coaching

Frightened, short-of-breath patients need clear, calm instructions to use a mask, inhaler or breathing technique properly.

Physical stamina

Twelve-hour shifts on your feet, moving equipment and turning patients take a toll without good body mechanics.

O*NET 31.0 rates these skills as most important for the occupation: active listening, critical thinking, monitoring, reading comprehension, speaking.

Training cost

$9.7K–$42.3K

Before financial aid

Time

2-3 years

Typical path

Median pay

$82,280

All US jobs: $50,980

Payback once qualified

0.3–1.4 yrs

Pay above the all-jobs median vs. cost

Low: 2 years x College Scorecard median public in-state tuition for allied health associate programs, $4,650 = $9,300, plus the NBRC TMC exam fee of $190 and the CSE fee of $200. High: 4 years x the bachelor's median, $10,470 = $41,880, plus $390 in NBRC exam fees. Not included: program and lab fees, books, uniforms, background checks, state license fees and living costs.

Rough guide only: ignores taxes, aid, interest and earnings given up during training. How we calculate it.

• Registered nurse$97,550 median

  Some RTs move into nursing through a nursing degree program, where prior science courses may count toward prerequisites, followed by the NCLEX-RN.

• Physician assistant$135,880 median

  Requires a bachelor's degree with prerequisites and a master's-level PA program; hospital RT experience gives the hands-on patient care background PA programs look for.

• Respiratory care manager or educator

  Usually needs the RRT, several years of experience and often a bachelor's or master's degree, which degree-advancement programs offer.

• Neonatal or critical care specialist RT

  Gain experience in a NICU or ICU and pass the NBRC's NPS or ACCS specialty exam.