How to become a respiratory therapist: the CoARC program, the CRT and RRT, the NBRC's new exam from January 2027 and the license

How to become a respiratory therapist in 2026: the accredited program and degree, the NBRC's CRT and RRT credentials and the new Respiratory Therapy Examination from January 2027, the license every state but one requires, what respiratory therapists are paid, and how new graduates get hired.

Respiratory therapists care for patients who cannot breathe well on their own: they run ventilators in intensive care, give breathing treatments, test lung function and respond to emergencies across the hospital. The path runs through an accredited program, a national credential from the National Board for Respiratory Care (NBRC) and a state license, and the NBRC's exams change in January 2027. This guide takes the steps in order from the NBRC's and the states' own rules, and every job figure in it opens the live list it comes from on CareJobs.Now, where 64,073 physical, occupational, speech and respiratory therapy jobs are open today, each read from the employer's own job board.

Contents

1. What respiratory therapists do
2. The program and the degree
3. The credentials: CRT and RRT
4. The exam change in 2027
5. Your state's license
6. What respiratory therapists are paid
7. Getting hired as a new graduate
8. A checklist

1. What respiratory therapists do

Respiratory therapists assess breathing, set up and manage ventilators, give inhaled medications and oxygen, draw and read arterial blood gases, help with intubation and airway care, and teach patients with chronic lung disease to manage it. Most work in hospitals, where respiratory care runs around the clock, so night, weekend and 12-hour shifts are common; others work in sleep labs, pulmonary rehab, home care and long-term acute care hospitals. Newborn and pediatric intensive care is a specialty of its own.

2. The program and the degree

The NBRC's credentials are built on graduating from a respiratory therapy program accredited by the Commission on Accreditation for Respiratory Care (CoARC). In the NBRC's words, an applicant for the advanced credential must "be a graduate of and have a minimum of an associate degree from an entry into practice respiratory therapy education program supported or accredited by the Commission on Accreditation for Respiratory Care (CoARC)". Programs award associate, bachelor's or master's degrees, with clinical rotations in hospitals alongside the coursework.

3. The credentials: CRT and RRT

The NBRC awards two levels: the Certified Respiratory Therapist (CRT) and the Registered Respiratory Therapist (RRT), which it calls "the standard of excellence" for respiratory care. In the NBRC's words, "The CRT and/or RRT credentials are used as the basis for the licensure in all 49 states that regulate the practice of respiratory care." Many hospitals ask for the RRT, or for a CRT who earns it within a set time, so plan for the RRT from the start.

4. The exam change in 2027

Until the end of 2026, the route is two exams: the Therapist Multiple-Choice (TMC) Examination, which awards the CRT at its low cut score and opens the Clinical Simulation Examination (CSE) at its high cut score, and the CSE, which completes the RRT.

From January 2027 the NBRC replaces them with one exam. In its words: "If you achieve the low cut score on the RT Examination, you earn the CRT credential. If you achieve the high cut score, you earn the RRT credential." The Respiratory Therapy Examination "consists of 185 multiple-choice items (160 scored items and 25 pretest items) taken over a four-hour period".

What this means for you, by the NBRC's own dates: the CSE "is available only for those who have passed the TMC Examination at the high cut score by Dec. 31, 2026", and "the CSE is scheduled to end on Dec. 31, 2027". If you graduate before the end of 2026 and pass the TMC at the high cut score, you can still finish the RRT through the CSE during 2027; if you test in 2027 or later, you take the new exam.

5. Your state's license

Every state but Alaska requires its own license or certificate to practice respiratory care today, and so does the District of Columbia; Alaska's license begins on January 1, 2027. Our respiratory therapist license requirements by state set each state's own rule side by side from its official pages, with the board that issues it and how it is renewed. Apply as soon as you pass the exam. The official rules of at least 11 states (among them Alabama, Kentucky, Louisiana, Oklahoma, Texas and Wisconsin) provide a temporary or provisional permit, often for new graduates waiting on the exam or the license; each state's page says what its rule provides.

The Respiratory Care Interstate Compact, which will let a therapist licensed in one member state practice in the others, has been enacted in 13 states but issues no privileges yet, so for now each state's own license is the way in.

6. What respiratory therapists are paid

Nationally, BLS measured a median of $39.56 an hour for respiratory therapists in May 2025. Open jobs post their own rates: our respiratory therapist pay page shows what open jobs post by state and by employer. Respiratory therapist jobs state a sign-on bonus more often than most therapy jobs; the therapy job statistics give today's share and median for respiratory therapists beside the other therapy occupations. Night and weekend shifts usually pay a differential.

7. Getting hired as a new graduate

Hospitals hire many respiratory therapists straight from school, often from the students who rotated through them. Some run new graduate residencies, especially in pediatric and newborn intensive care; our new grad healthcare jobs list the therapy jobs whose titles name a new graduate or a residency, and our respiratory therapist jobs every open respiratory therapist job. If you want to move later, our moving to another state as a therapist guide covers the license side.

8. A checklist

1. Choose a CoARC-accredited respiratory therapy program, with at least an associate degree.
2. Check which NBRC exam you will take: the TMC and CSE through 2026 and 2027, or the Respiratory Therapy Examination from January 2027.
3. Earn the CRT, and the RRT that most hospitals ask for.
4. Apply for your state's license, or temporary permit, as soon as you pass: license requirements by state.
5. Apply where you rotated, and to new grad residencies: respiratory therapist jobs.