How to Become a Respiratory Therapist in 2026
Respiratory therapy is one of the fastest-growing healthcare careers in the US, with demand fueled by an aging population and rising chronic respiratory disease rates. If you're considering this career, here's what the path looks like from start to finish — including what it actually takes to pass the RRT exam.
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Step-by-Step Path to Becoming a Respiratory Therapist
Step 1: Complete an Accredited Respiratory Therapy Program
You need at least an associate's degree in respiratory therapy from a program accredited by the Commission on Accreditation for Respiratory Care (CoARC). However, the industry is shifting toward requiring a bachelor's degree — and this matters for your career:
| Degree Level | Duration | Starting Salary Impact | Career Ceiling |
|---|---|---|---|
| Associate's (AS) | 2 years | Qualifies for entry-level RRT | Limited advancement without more education |
| Bachelor's (BS) | 4 years | $3,000–$7,000 higher starting salary | Management, education, specialty roles |
| Master's (MS) | 2 additional years | Required for some advanced positions | Department director, research, academia |
Important 2026 update: The AARC (American Association for Respiratory Care) continues to advocate for the bachelor's degree as the entry-level standard. While associate's programs are still accredited and valid, many hospitals now prefer or require a BS for new hires. If you're starting school now, strongly consider the 4-year route.
As of 2026, there are approximately 350 CoARC-accredited programs across the US. Your program must include:
- Anatomy and physiology
- Cardiopulmonary pathophysiology
- Patient assessment
- Mechanical ventilation
- Neonatal/pediatric respiratory care
- Clinical rotations (typically 500+ hours)
Step 2: Pass the TMC (Therapist Multiple-Choice) Exam
After graduating, you must pass the TMC exam administered by the National Board for Respiratory Care (NBRC):
| Exam Detail | TMC Exam |
|---|---|
| Questions | 160 (140 scored, 20 pretest) |
| Time | 3 hours |
| Format | Multiple-choice, computer-based |
| Scoring | Two cut scores — CRT level and RRT level |
| Cost | $190 |
| Testing | Pearson VUE centers year-round |
The TMC has two passing thresholds:
- Low cut score → Earns the CRT (Certified Respiratory Therapist) credential
- High cut score → Earns the RRT (Registered Respiratory Therapist) credential
You want the RRT. The RRT is the standard credential expected by employers. The CRT alone limits your job options significantly.
Step 3: Pass the Clinical Simulation Exam (CSE) — If Needed
If you score at the CRT level (above the low cut but below the high cut) on the TMC, you can still earn the RRT by passing the Clinical Simulation Exam (CSE):
| Exam Detail | CSE |
|---|---|
| Format | Clinical scenarios with branching decision trees |
| Scenarios | 22 simulations (11 scored, 11 pretest) |
| Time | 4 hours |
| Cost | $200 |
| Content | Patient assessment, treatment decisions, emergency management |
Critical 2026 update: The NBRC has been evaluating changes to the CSE format. The current CSE uses an older computer-based branching format. Check the NBRC website for the latest exam information before scheduling.
Step 4: Obtain State Licensure
All 50 states, the District of Columbia, and Puerto Rico require respiratory therapists to be licensed. Requirements vary but typically include:
- Graduation from a CoARC-accredited program
- Passing the NBRC exams (TMC and/or CSE)
- Background check
- State application fee ($50–$200)
- Continuing education for license renewal
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Respiratory Therapist Salary in 2026
Respiratory therapy pays well, especially considering the education investment is as short as 2 years:
National Salary Overview
| Metric | Amount (2026 Estimates) |
|---|---|
| Median Annual Salary | $77,960 |
| Hourly Median | $37.48 |
| Bottom 10% | $57,500 |
| Top 10% | $95,540+ |
| Median with BS degree | $82,000–$88,000 |
Salary by State (Top 10 Highest-Paying)
| Rank | State | Mean Annual Salary | Notes |
|---|---|---|---|
| 1 | California | $95,540 | Highest pay, high cost of living |
| 2 | New York | $89,300 | NYC metro drives the average up |
| 3 | New Jersey | $86,220 | Strong hospital systems |
| 4 | Hawaii | $85,490 | High demand, limited supply |
| 5 | Connecticut | $84,740 | Major health systems |
| 6 | Massachusetts | $83,900 | Academic medical centers |
| 7 | Washington | $82,800 | Growing healthcare sector |
| 8 | Alaska | $82,200 | Remote premium |
| 9 | Oregon | $80,900 | Competitive market |
| 10 | Nevada | $80,400 | Growing population |
Salary by Work Setting
| Setting | Typical Salary Range | Notes |
|---|---|---|
| Hospitals (general) | $72,000–$88,000 | Most common employer (73% of RTs) |
| ICU/Critical Care | $78,000–$95,000 | Higher acuity = higher pay |
| Travel RT | $85,000–$120,000+ | Includes housing stipends |
| Home Health | $65,000–$78,000 | Growing sector, more autonomy |
| Sleep Lab | $62,000–$75,000 | Regular hours, less acute |
| Pulmonary Rehab | $65,000–$80,000 | Outpatient setting |
| NICU (Neonatal) | $78,000–$95,000 | Specialized, high demand |
Job Outlook and Demand (2024–2034)
The Bureau of Labor Statistics projects respiratory therapy jobs will grow 13% from 2024 to 2034 — much faster than the average for all occupations (4%):
| Metric | Data |
|---|---|
| Employment (2024) | ~136,000 respiratory therapists |
| Projected Growth | 13% (2024–2034) |
| New Jobs Expected | ~17,700 |
| Annual Openings | ~8,600 (includes replacements) |
| Growth Drivers | Aging population, COPD/asthma prevalence, post-COVID demand |
Why Demand Is So High
- Aging population — The 65+ population is the fastest-growing demographic, and respiratory conditions increase with age
- Chronic disease prevalence — COPD is the 4th leading cause of death in the US; asthma affects 25+ million Americans
- Post-COVID impact — Long COVID and increased awareness of respiratory health has expanded RT roles
- Sleep medicine growth — Sleep apnea diagnosis rates continue to climb, creating demand for sleep lab specialists
- Home health expansion — More patients receive respiratory care at home, creating new roles outside hospitals
Respiratory Therapy Specializations
Once you have your RRT, you can specialize to increase your salary and career options:
| Specialization | Additional Credential | Salary Premium | Requirements |
|---|---|---|---|
| Neonatal/Pediatric | NPS (NBRC) | +$5,000–$12,000 | 1+ year NICU experience + exam |
| Adult Critical Care | ACCS (NBRC) | +$5,000–$10,000 | 1+ year ICU experience + exam |
| Sleep Disorders | SDS (NBRC) | +$3,000–$8,000 | Sleep lab experience + exam |
| Pulmonary Function | CPFT/RPFT (NBRC) | +$3,000–$7,000 | PFT lab experience + exam |
| ECMO Specialist | Hospital-specific | +$8,000–$15,000 | Specialized training |
| Transport/Flight RT | CFRN or equivalent | +$10,000–$20,000 | Experience + additional certs |
| Asthma Educator | AE-C (NAECB) | +$3,000–$5,000 | Education + exam |
Continuing Education & License Renewal
Respiratory therapists must complete continuing education to maintain their credentials:
| Requirement | Details |
|---|---|
| NBRC credential renewal | Every 5 years |
| State license renewal | Every 1–2 years (varies by state) |
| CE hours | 30 hours per 5-year cycle (NBRC minimum) |
| State CE requirements | Vary — some require more than NBRC minimum |
| Approved CE providers | AARC, state RT societies, accredited programs |
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Over 8,600 respiratory therapy jobs open annually. Your career starts with passing the RRT exam.
Official Resources
- National Board for Respiratory Care (NBRC) — Exam registration and credential information
- Commission on Accreditation for Respiratory Care (CoARC) — Find accredited programs
- American Association for Respiratory Care (AARC) — Professional association, CE opportunities
- Bureau of Labor Statistics — Respiratory Therapists — Career outlook data