Guide — RT Career & Professional Practice
The RT Credentialing Pathway
Becoming a respiratory therapist runs through a defined credentialing sequence: an accredited program, a multiple-choice board exam with two cut scores, and a clinical simulation exam. This guide maps how the CRT and RRT credentials are earned and what each one means.
8 min read · RT Career & Professional Practice
Written by Apex Respiratory Editorial Team
Educational use only. This material supports respiratory therapy education and exam review. It is not medical advice and is not a substitute for clinical judgment, institutional protocols, or physician orders. Always follow facility policies and current provider orders, and verify calculations independently before clinical use.
Overview
Credentialing is the structured route from student to practicing respiratory therapist. The sequence runs from accredited education through national board examinations to the CRT and/or RRT credential, followed by state licensure. Two organizations anchor the system: the National Board for Respiratory Care (NBRC) administers the credentialing examinations, and the Commission on Accreditation for Respiratory Care (CoARC) accredits the educational programs that make candidates eligible to sit those exams.
Understanding the sequence — and the distinctions between credentials, exams, and licensure — is essential for anyone entering or advising in the respiratory therapy profession.
Key Concepts
Eligibility for the NBRC examinations begins with graduation from a CoARC-accredited respiratory care program. The minimum educational requirement is an associate degree, though many programs award a baccalaureate, and the profession is actively moving toward the bachelor’s degree as the preferred entry-level credential. Candidates must confirm their program holds CoARC accreditation before enrolling, as graduation from a non-accredited program disqualifies them from sitting the board examinations.
- CoARC accreditation. Required for exam eligibility — not optional. Verify accreditation status through the CoARC website before enrolling in any program.
- Degree level. Associate degree is the current minimum; baccalaureate programs are increasingly common and professionally preferred.
- Exam eligibility window. Candidates have a defined period of eligibility after applying. Allowing eligibility to lapse requires reapplication.
The Board Examinations
The NBRC administers two examinations in the credentialing sequence. Both are computer-based and administered at authorized testing centers.
| Examination | Format | Outcome |
|---|---|---|
| Therapist Multiple-Choice (TMC) | Multiple-choice | Low cut score → CRT credential. High cut score → CRT credential + eligibility to sit the CSE. |
| Clinical Simulation Examination (CSE) | Branching case-based simulation | Passing (after TMC high cut score) → RRT credential. |
The Therapist Multiple-Choice (TMC) Examination is the gateway. It carries two passing thresholds: the low cut score and the high cut score. Meeting the low cut score earns the CRT credential. Meeting the high cut score earns the CRT and opens eligibility for the Clinical Simulation Examination (CSE). The CSE is a branching, case-based simulation exam; passing it — after achieving the TMC high cut score — earns the RRT credential.
CRT vs. RRT
The two national credentials represent different points on the credentialing continuum. Understanding what each one requires and signals is important for career planning.
| Credential | Requirement | Significance |
|---|---|---|
| CRT — Certified Respiratory Therapist | Meet the TMC low cut score. | Entry-level national credential; required for state licensure in most states. |
| RRT — Registered Respiratory Therapist | Meet the TMC high cut score AND pass the CSE. | Advanced/registered credential; increasingly the employer and specialty-credential standard. |
The RRT is increasingly the standard expected by employers and is required as a prerequisite for most NBRC specialty credentials (such as ACCS, NPS, SDS, and others). A CRT and an RRT each meet the requirements to sit for state licensure in most states, but specific state requirements vary — always verify current state rules.
Common Pitfalls
- Assuming one exam earns the RRT. The RRT requires two distinct steps: the TMC at the high cut score, then a passing score on the CSE. Meeting only the TMC high cut score earns the CRT and eligibility — not the RRT itself.
- Confusing the national credential with the state license. The CRT and RRT are national credentials issued by the NBRC. Most states also require a separate state license before a therapist may legally practice. Both are needed; one does not substitute for the other.
- Not confirming CoARC accreditation before enrolling. Graduation from a non-accredited program disqualifies a candidate from sitting the NBRC examinations. Accreditation status can change, so verify directly with CoARC.
- Letting exam eligibility lapse. NBRC exam eligibility periods are finite. Missing the window requires reapplication and can delay credentialing significantly.
Key Takeaways
- The pathway in order:CoARC-accredited program → TMC Examination (two cut scores) → CSE (if seeking RRT) → CRT or RRT credential → state licensure.
- CRT from TMC low cut score. Meeting the low cut score on the TMC awards the CRT credential. No CSE required.
- RRT requires both steps. The TMC high cut score earns the CRT and CSE eligibility; passing the CSE then earns the RRT.
- Credential ≠ license. The national NBRC credential and the state license are separate requirements; confirm both for your practice jurisdiction.
FAQ
What is the difference between a CRT and an RRT?
The CRT (Certified Respiratory Therapist) is the entry-level national credential, earned by meeting the low cut score on the Therapist Multiple-Choice (TMC) Examination. The RRT (Registered Respiratory Therapist) is the advanced credential and requires meeting the high cut score on the TMC and then passing the Clinical Simulation Examination (CSE). The RRT is increasingly the standard expected by employers and is required for specialty credentials.
What do the two TMC cut scores mean?
The TMC Examination has a low cut score and a high cut score. Achieving the low cut score earns the CRT credential. Achieving the high cut score also earns the CRT and additionally makes the candidate eligible to sit the Clinical Simulation Examination (CSE), which is the next step toward the RRT.
Do I need the CSE to earn the CRT credential?
No. The CRT is awarded upon meeting the low cut score on the TMC Examination. The Clinical Simulation Examination (CSE) is only required for the RRT credential, and only candidates who meet the TMC high cut score are eligible to sit it.
Is the national credential the same as a state license to practice?
No. The CRT and RRT are national credentials administered by the NBRC. Most states require a separate state license to legally practice as a respiratory therapist. Credential and licensure requirements are distinct, and both are typically required before practicing clinically.
Put it to work
Practice the multiple-choice format the entry board exam uses — free board-style quizzes with a rationale on every answer.
Open the practice quizzes →Related Resources
Sources
- National Board for Respiratory Care. Candidate credentialing information and detailed content outlines (TMC and Clinical Simulation Examinations). NBRC.
- Kacmarek RM, Stoller JK, Heuer AJ. Egan's Fundamentals of Respiratory Care. 12th ed. Elsevier; 2021. The respiratory care profession.