How to Become a Respiratory Therapist

Where Respiratory Therapists have the most money left over after rent

Median pay minus estimated federal + state + FICA taxes, minus 12 months of rent at HUD's 2-bedroom Fair Market Rent. Darker green means more money left over each year. Hover any state for the breakdown.

Education and training

Respiratory therapists need an associate degree from a CoARC-accredited program (2 years) at minimum, though bachelor's programs are becoming the standard. Coursework covers cardiopulmonary anatomy, pharmacology, patient assessment, mechanical ventilation, neonatal care, and diagnostics. Clinical rotations include adult critical care, neonatal ICU, emergency department, and pulmonary rehabilitation.

The shift toward bachelor's-as-entry-level mirrors what nursing went through 20 years ago. The AARC (professional association) has endorsed the bachelor's as the preferred entry credential. Associate-degree RTs can still get licensed and work, but bachelor's-prepared RTs increasingly get hiring preference at major hospitals.

Clinical rotations typically total 1,000+ hours across adult ICU, neonatal ICU, emergency department, pulmonary function lab, and general medical floors. The NICU rotation is where many students discover their calling, managing tiny ventilators on premature infants requires a precision and emotional resilience that sets neonatal RTs apart from adult practitioners.

Licensing and certification

RTs must pass the Therapist Multiple-Choice (TMC) exam through NBRC. Scoring at the high cut score earns the Registered Respiratory Therapist (RRT) credential; the low cut score earns the Certified Respiratory Therapist (CRT). Virtually all employers prefer or require RRT. Most states require state licensure in addition to NBRC credentials.

Specialty credentials are available in neonatal/pediatric, adult critical care, sleep disorders, and pulmonary function technology. Each requires additional experience hours and exams.

What the day-to-day looks like

RTs manage ventilators for critically ill patients, administer breathing treatments (nebulizers, inhalers), perform arterial blood gas draws and analysis, set up and monitor oxygen therapy, assist with intubations, and respond to respiratory emergencies (code blue teams). The work is heavily concentrated in ICUs and emergency departments.

COVID-19 permanently elevated the profession's visibility and demand. RTs were the front-line managers of ventilators during the pandemic, and hospitals learned the hard way that having too few RTs is a critical vulnerability. Staffing ratios have improved in many facilities as a result.

The RT-to-patient ratio in ICUs is typically 4-6:1, meaning you manage multiple ventilated patients simultaneously. Each vent requires different settings based on the patient's lung disease, oxygenation status, and tolerance. Alarm fatigue is real: ventilator alarms sound constantly, and distinguishing a critical alarm from a nuisance alarm is a skill that comes with experience. Night shifts tend to be busier than you'd expect because respiratory events (asthma attacks, COPD exacerbations, sleep apnea crises) peak in the late evening and early morning hours.

Career progression

Entry-level RT → lead therapist → supervisor → department director. Clinical advancement through specialty credentials adds $3,000-$8,000/year. Some RTs pursue perfusion (operating heart-lung machines during cardiac surgery), which requires additional education but commands $100,000-$130,000 salaries.

Travel RT positions pay $1,500-$2,200/week gross. The RT travel market is smaller than nursing but growing, with strong demand in regions where respiratory census runs high (winter flu season, wildfire smoke season).

Salary progression

Highest paying states

Where the jobs are

Salary negotiation

RT demand surged post-COVID and hasn't fully normalized. Shift differentials (nights and weekends), sign-on bonuses ($3,000-$10,000), and critical care premium pay are common negotiation targets. RTs with ECMO (extracorporeal membrane oxygenation) experience command significant premiums, ECMO-trained RTs are rare and essential for advanced critical care programs.

What the data doesn't tell you

RT is one of healthcare's best-kept salary secrets. The median is $77,960, comparable to many bachelor's-degree careers, and the entry requirement is an associate degree. The ROI on education investment is among the best in allied health.

Frequently asked questions