Respiratory therapists are medical professionals who work with patients that have minor or significant breathing problems. People in this field focus on the cardiopulmonary system and provide respiratory care to patients of all ages. You will find respiratory therapists mainly working in hospitals with a variety of patients like premature babies to the elderly. Respiratory therapists’ responsibilities are very specialized, so they need a deep understanding of the tools and techniques required for their job. As such, aspiring respiratory care professionals must complete a degree focusing on this field. They must also obtain two certifications, along with a state license, before they can practice.


Why do certifications matter?

Certifications are useful because they demonstrate you have a deep understanding of respiratory care and allow you to practice without working under the complete supervision of someone else. They also provide you with more excellent opportunities that come with more responsibilities and higher pay. If you’re looking to go into management for respiratory care, certifications can be a great way to boost your career trajectory after graduation. 


Before you can get your license to practice legally, you may be required by your state to pass two tests to get your needed certifications. Each test comes with certification so that you will gain an entry-level certification and an advanced certification in the process. There are other optional exams you can complete to further specialize in respiratory therapy, such as neonatal/pediatrics, sleeping disorders, and adult critical care.


The National Board for Respiratory Care (NBRC) is a nonprofit that has set the standard for respiratory care credentials for over 50 years. Their mission is to:


  • Providing high-quality exams to validate a respiratory care professional’s credentials
  • Establish standards for certifying respiratory care practitioners
  • Advance medicine by funding research and promoting the value of respiratory care
  • Support respiratory care education by partnering with other established organizations
  • Leverage their time, knowledge, and resources to elevate the profession


What is a CRT?

The NBRC provides two levels of certifications for aspiring respiratory therapists. The first one is the entry-level certification, called the Certified Respiratory Therapist (CRT). To earn the CRT, you must be over 18 years old and currently hold a minimum of a two-year degree from an accredited program or be in the process of completing an accredited four-year degree. You must also pass the Therapist Multiple-Choice (TMC) Exam. This exam has 140 multiple-choice questions that cover three topic areas:


  • Patient data assessment and recommendations
  • Troubleshooting, quality assurance of equipment, and infection control
  • Initiation and modifications of interventions

Test takers will have three hours to complete the exam.



What is a RRT?

The second one is the advanced-level certification, call the Registered Respiratory Therapist (RRT). To apply for the RRT, you must pass the CRT and obtain a high enough score on it. If you do not earn a high enough score on the CRT, you can always apply for the RRT later once your score is good. The RRT includes the same multiple-choice questions from the CRT exam as well as open-ended Clinical Simulation Exam (CSE) that are meant to test your skills as a respiratory therapist. You will need to pass the multiple-choice portion with a higher score than before. The CSE includes 22 patient management problems that are meant to simulate real clinical practice scenarios. Examinees will be given four hours to complete this portion of the test.


To complete the Clinical Simulation Examination (CSE), you must meet one of the following requirements:

  • Be a recent graduate of an associate’s or bachelor’s degree program in respiratory care and is accredited. You would then need to complete the Therapist Multiple-Choice (TMC) Exam with a higher score as determined by the NBRC.
  • Hold a CRT credential and have four years of full-time healthcare experience in respiratory therapy under the supervision of a licensed clinical provider. You will also need at least 62 semester hours of college credit in the courses listed below:
    • Physics
    • Chemistry
    • Math
    • Microbiology
    • Physiology and Anatomy
  • Hold a CRT credential as well as a bachelor’s degree in a program other than respiratory therapy with college courses in the list provided below. Applicants must also have at least two years of full-time healthcare experience in respiratory therapy under the supervision of a licensed clinical provider and at least 62 semester hours from an accredited school.
    • Physics
    • Chemistry
    • Math
    • Microbiology
    • Physiology and Anatomy


Please note: There’s a 3-year eligibility limit for CRT and RRT certifications.


New graduates of respiratory care programs have three years after graduating to complete the examination process for the CRT and RRT certifications. The NBRC approved this limit to ensure respiratory therapists who consider themselves to be “ready” are motivated to take the exam in a reasonable time frame after earning their CRT credential. If you do not meet the time limit, you must retake the Therapist Multiple-Choice (TMC) exam to apply for the RRT certification.

Additional Certifications for specializing:

  • Neonatal/Pediatric Specialist (RRT-NPS): This test checks the skills and understanding of RT who work in either neonatal or pediatric care work environments. It assesses whether you have the right assessment strategies and treatment methods for your smallest patients.
  • Sleep Disorders Specialist (CRT-SDS or RRT-SDS): This exam measures the competency of RTs who conduct sleep disorders testing and therapeutic intervention.
  • Adult Critical Care Specialist (RRT-ACCS): This test assesses your skills needed to work in a critical care environment as a RT. This exam covers critical care scenarios, as well as general critical care.
  • Pulmonary Function Technologist (CPFT or RPFT): This test looks at the skills and knowledge of respiratory therapists that run respiratory tests and diagnose breathing disorders.

How to renew your certifications?

There are several options for renewing your respiratory care certifications, which expire every five years. To restore your certifications, you can complete thirty continuing education hours every five years, obtaining a higher certification during the same period, or just retaking the corresponding certification exam. If you go through the continuing education course route, there are online courses available to you for credit.


What are the costs of each certification?


Credential NameExam FeeDiscount offered?
Certified Respiratory Therapist$190 for new applicants, $150 for re-applicants$40 off, one time for AARC Members
Registered Respiratory Therapist$200 for both new applicants and re-applicants
Pulmonary Function Technologist$200 for new applicants, $170 for re-applicants
Neonatal/Pediatric Specialist$250 for new applicants, $220 for re-applicants
Sleep Disorders Specialist$300 for new applicants and $250 for re-applicants
Adult Critical Care Specialist$300 for new applicants and $250 for re-applicants


What about state licenses?

In every state, except Alaska, practicing respiratory therapists are required to have a license. Although the requirements to obtain a license can vary by state. A lot of states require applicants to receive a certification from NBRC before they attempt to get a license. General requirements for a license can include proof of citizenship or state residency, background check, payment of administrative fees, proof of program completion from the school you attended. Make sure to check with your state for special requirements before applying for a license.

Once a license is obtained, it must be maintained and renewed. The typical periods for renewal are 3 to 5 years, but this can vary by state. Some states will also require continuing education to stay licensed. Other states may require certifications to be upheld and renewed as a part of the licensing agreement.




Leave a Reply