Steps to Becoming a Respiratory Therapist - Education, Certification & Experience

“What can we do but keep on breathing in and out, modest and willing, and in our places?”

Mary Oliver

Breathing is a subconscious part of everyday life and most people don’t give it a second thought unless they are meditating, in a yoga class, or are experiencing breathing difficulties. Thankfully for those struggling with their breath, there are educated and credentialed breathing therapists at the ready.

Respiratory therapy, which is the assessment and treatment of patients with cardiopulmonary dysfunction, became a recognized field in the late 1940s. Respiratory therapists utilize tools, medicine, and education to provide respiratory support to individuals. Patients can need a respiratory therapist because of acute conditions such as croup or pneumonia, or because of chronic conditions such as birth defects, asthma, or chronic obstructive pulmonary disease (COPD).

As the population of the United States continues to age there has been a steady increase in the demand for respiratory therapists. Jobs in this field are expected to grow 19 percent from 2019 to 2029, far outpacing the national average for all fields (4 percent). Those wishing to pursue a career in this field can choose to obtain the certification of either a Certified Respiratory Therapist (CRT) or a Registered Respiratory Therapist (RRT).

All states, except for Alaska, require certification and licensure in order to work as a respiratory therapist. As of December 2020, the American Association for Respiratory Care (AARC) reports a growing list of states that require the more advanced RRT certification for state-level licensure including Arizona, California, Ohio, Oregon, New Jersey, and New Mexico. Both certifications require at least an associate degree. Once a professional certification is obtained, respiratory therapists can pursue specialty credentialing as a Neonatal/Pediatric Specialist, Adult Critical Care Specialist, or Sleep Disorders Specialist.

Check out a step-by-step guide to becoming a certified respiratory therapist.

Step 1: Graduate from High School or Pass the GED (Four Years)

Completing high school or a GED is the first step towards becoming a respiratory therapist. It demonstrates a commitment to completing a program as well as a basic level of education. High school courses in anatomy, biology, chemistry, and advanced math are recommended. Students can also take AP courses and tests to receive college credit prior to graduating.

Step 2: Complete a COARC-Accredited Program or (Two to Six Years)

The Commission on Accreditation for Respiratory Care (CoARC) maintains strict standards for respiratory therapy education programs. Programs are available in most states and vary in length from two to six years. Most programs require that the student complete an associate of science (AS) or associate of applied science (AAS) degree, while others require a four-year bachelor of science degree. Students wishing to pursue more advanced studies will find seven master’s degree programs available across the country.

Attending an accredited program will ensure students have a smooth path towards licensure. Programs within the accrediting association make it easier to apply for financial aid, transfer credits, and obtain higher degrees.

Throughout the course of study, students learn how to gather and interpret clinical data, how to communicate effectively with patients and families, and how to perform therapeutic and diagnostic procedures.

Texas State University
Carlow University
University of Cincinnati Online

Step 3: Apply for the Therapist Multiple-Choice (TMC) Examination (Timeline Varies)

Candidates who are 18 years old and have completed an associate, bachelor’s, or master’s degree from a CoARC-accredited program may apply to sit for the Therapist Multiple-Choice (TMC) examination to become a Certified Respiratory Therapist (CRT) through the National Board for Respiratory Care (NBRC). This three-hour test objectively evaluates a student’s knowledge, skills, and ability as a respiratory therapist.

To apply, students can fill out an online or paper application and submit it along with a $190 fee. Upon approval, the student receives a link and a toll-free number to schedule their test. The test must be scheduled and taken within 90 days of receiving eligibility approval, or a new application and fee must be submitted. There is no deadline to apply and students may submit their application whenever they meet eligibility.

Step 4: Pass the TMC Examination (Timelines Vary)

On examination day students should arrive on time at their testing center. In order to be admitted to the test, students will need to provide two forms of identification, one of which must be a photo ID. After leaving all their belongings in a locker, students are given a pencil and one piece of scratch paper and shown to the computer they will be using for the test. Prior to starting the test, students may take a practice test. The time taken on the practice test will not affect the time allowed for the formal test.

During the three-hour test, students are required to answer 160 questions of which only 140 are scored. The other 20 are pre-test questions and are used to test new questions and do not affect the student’s final score.

Immediately following the test, students receive their scores. For this test, students can receive a “low cut score,” which credentials them as a CRT or a “high cut score,” which credentials them as a CRT and makes them eligible to sit for the Clinical Simulation Examination (CSE) as long as they meet the other requirements for the test.

Detailed test content outlines are available from the NBRC but students can expect to be tested on:

  • Patient data evaluations and recommendations
  • Troubleshooting and quality control of equipment, and infection control
  • Initiation and modification of interventions
  • Patient conditions

Free practice tests are available from the NBRC to help students prepare for the test. Further, students who wish to assess their readiness for the TMC test may purchase the Self Assessment Examination (SAE) which mimics the actual exam.

Step 5: Apply for State Licensure (Most States, Timelines Vary)

Every state except for Alaska requires that respiratory therapists be licensed. In most states licensing can be done upon passing the TMC examination, submitting an application either online or on paper, and paying a fee. Some states also require a criminal background check. Requirements vary by state and care should be exercised to ensure all the qualifications are met.

Step 6: Apply for the Clinical Simulation Examination (CSE) (Optional Depending on State, Timelines Vary)

In order to be credentialed as a Registered Respiratory Therapist (RRT) students must pass both the TMC and Clinical Simulation Examination (CSE) exams. This test is a clinical simulation exercise designed to further test the student’s aptitude as a respiratory therapist.

For some states, such as Arizona, California, Ohio, Oregon, New Jersey, and New Mexico, an RRT certification is required in order to receive licensure. Students who have completed at least an associate degree from a CoARC-accredited program and received a “high cut score” on the TMC may apply for eligibility to take the CSE exam. Students must complete the requirements for their RRT certification within three years of graduating or they must retake the TMC with a new high cut score in order to be eligible for the CSE test.

To apply, students can fill out an online or paper application and submit it along with a $200 fee. Upon approval, the student receives a link and a toll-free number to schedule their test. The test must be scheduled and taken within 90 days of receiving eligibility approval, or a new application and fee must be submitted. There is no deadline to apply and students may submit their application whenever they meet eligibility.

Step 7: Pass the CSE Test (Optional Depending on State, Timeline Varies)

On examination day students should arrive on time at their testing center. In order to be admitted to the clinical simulation exam (CSE), students will need to provide two forms of identification, one of which must be a photo ID. After leaving all their belongings in a locker, students are given a pencil and one piece of scratch paper and shown to the computer they will be using for the test. Prior to starting the test, students may take one problem simulation exercise. The time taken on the practice problem will not affect the time allowed for the formal test.

Students will have four hours to work through 22 clinical scenario problems. During this test, students will be given a simulation with a brief patient description then asked questions on the next steps with the patient. Over the course of the scenario, the patient status will change and the student will need to make appropriate adjustments and decisions.

Only 20 scenarios count towards the overall score and two questions are pretest problems that are being trialed for future tests. Students should thoroughly review their course materials prior to taking the test. Online test content outlines are available as well.

Free practice tests are available from the NBRC to help students prepare for the test. Further, students who wish to assess their readiness for the CSE test may purchase the Self Assessment Examination (SAE) which mimics the actual exam.

Step 8: Secure an Entry-Level Respiratory Therapist Job

A nationwide increase in the middle-aged and elderly populations has led to an increase in incidents of respiratory conditions such as chronic obstructive pulmonary disease (COPD) and pneumonia. This in turn is driving demand for more respiratory therapists and the profession is expected to grow by at least 19 percent between 2019 and 2029 (BLS 2020).

Newly credentialed and licensed CRTs and RRTs can seek employment at hospitals, rehabilitation centers, long-term care facilities, sleep disorder clinics, and diagnostic laboratories. One place to begin the job search is with professional organizations in the respiratory therapy field.

The American Association for Respiratory Care (AARC) has a job board as does the CoARC. More general job boards such as LinkedIn, Indeed, and Monster also list postings for numerous respiratory therapist positions.

Step 9: Apply for Specialty Credentialing Examination (SCE) (Optional, Timelines Vary)

After obtaining certification as an RRT, many professionals choose to pursue specialty certification. The only requirement to be able to take the exam for Neonatal/Pediatric Specialist is holding an RRT certification. The Adult Critical Care Specialist and Sleep Disorders Specialist requires that you have worked as an RRT for a period of time before being eligible for the exams.

For more details on how to earn specialty certification for respiratory therapists, please see our guide to Respiratory Therapy Certification.

Helpful Resources for Nbrc-Certified Respiratory Therapists

There are numerous resources to help professionals on the path to becoming a certified respiratory therapist. Here are some of the most commonly accessed sites:

  • National Board for Respiratory Care (NBRC)
  • American Association for Respiratory Care (AARC)
  • Commission on Accreditation for Respiratory Care (CoARC)
  • AARC state licensure requirements list
  • NBRC exam frequently asked questions
  • CoARC job board
Kimmy Gustafson
Kimmy Gustafson Writer

With her passion for uncovering the latest innovations and trends, Kimmy Gustafson has provided valuable insights and has interviewed experts to provide readers with the latest information in the rapidly evolving field of medical technology since 2019. Kimmy has been a freelance writer for more than a decade, writing hundreds of articles on a wide variety of topics such as startups, nonprofits, healthcare, kiteboarding, the outdoors, and higher education. She is passionate about seeing the world and has traveled to over 27 countries. She holds a bachelor’s degree in journalism from the University of Oregon. When not working she can be found outdoors, parenting, kiteboarding, or cooking.