Respiratory care is clearly one of the fastest growing allied health professions. There are several reasons: an increase in the elderly population; the impact of environmental problems on the number of reported asthma cases; and technological advances. With RTs in such hot demand, many of the 400-plus community colleges, universities, and private schools offering respiratory care training have strengthened their programs in recent years.

Regardless of how the curriculum is structured, respiratory care schools have been paying special attention to the expanding role of the respiratory therapist in the clinical setting. As respiratory therapists have taken on increased responsibilities as members of the health care team, it has become imperative for the schools to offer classroom instruction and clinical training that adequately prepare them for their jobs.

Even though the schools’ curriculums have become stronger, however, veterans of the field believe that RTs in today’s health care environment need to take responsibility for their education as much as they can. “The amount of information they need to learn has increased tremendously over the last several years, and it is difficult to teach everything in detail,” stresses Sherry Blansfield, MBA, RRT, manager of respiratory care services at 224-bed Anaheim Memorial Medical Center in Anaheim, Calif. “If they do not take the initiative in enhancing their knowledge through independent exercise, it becomes obvious during the interview process or during their orientation process.”

School Selection

The first, and probably most important, step of the educational process is the selection of the respiratory care school. Although the majority of credentialed programs last 24 months, some schools have an 18-month curriculum and some are incorporated into a 4-year bachelor’s degree program. Given the increasing knowledge base for the field, most experts believe that the 18-month program does not adequately train RTs. “They fulfill a need in some rural areas, but most hospitals today avoid hiring graduates of 18-month programs,” notes John Peleuses, RRT, director of respiratory services, Irvine Regional Hospital and Medical Center, Irvine, Calif. In determining which school to attend, Peleuses suggests evaluating three key areas: student/teacher ratio, the amount of clinical time required while in the program, and the school’s hospital affiliations.

Mindy Pera, CRTT, clinical educator for Children’s Hospital of Orange County (CHOC) in Orange, Calif, agrees that prospective students should evaluate respiratory care programs carefully. As a supervisor of recent graduates, she found that one particular school’s students had difficulty passing their entry-level examinations and as a result were let go. Later she learned that many of the students at this school had participated in independent study during their training, which could have been the explanation for the lack of preparation. CHOC does not hire students from 18-month programs. “Despite some rare exceptions, I have been fairly impressed with graduates from most 24-month programs,” says Pera. “Most of the schools have up-to-date modalities and the most current technology, but some have more than others.”

Another decision is whether to enroll in a private or public college. According to Blansfield, many of her new hires who attended a private college did so because they believed they could complete the program faster and find a job in less time. “They were willing to pay three to four times the cost of a public community college to get through the program up to approximately 9 months faster,” says Blansfield. Although private colleges often offer accelerated programs, many respiratory care managers believe graduates from these programs were less prepared when they were first hired.

Nish Patel, RRT-NPS, who graduated from a private school in January 2006 and currently works at Anaheim Memorial Medical Center, has mixed feelings about his education. Although he felt the clinical coursework and professional networking opportunities were more than adequate, he thought that the teachers could have been stronger. Patel also believes that the respiratory care programs should have more challenging admission requirements. “Students should have a minimum of an AA degree, or at least close to it, for admission,” says Patel, who is currently enrolled in a postprofessional respiratory care program at Loma Linda University in Loma Linda, Calif.

Some RTs prefer to attend 4-year programs in order to receive a bachelor’s degree. Most of these individuals hope to eventually move into management. Although this is a good option for highly motivated students, Blansfield believes that if too much emphasis is placed on the BS degree, it could be potentially detrimental for the profession. “If the profession required a BS degree, many of these students would opt out of respiratory care and go into another profession,” she says. Blansfield adds that at most institutions, the BS degree does not command higher pay scales for respiratory therapists, unlike in nursing and other health care positions. “If we were to require a BS degree, I believe there would be fewer people entering the profession, so unfortunately it does not make economical sense.”

Peleuses, who is a strong believer in professional education, notes that traditional coursework does not provide the only path to attaining one’s goals within the respiratory therapy field. He stresses to students that their desire and initiative will pay off greatly if they seek out new opportunities. “I try to tell them to look outside the traditional box of treating respiratory therapy patients,” he says. “Many therapists become an integral part of the management team because they’re not afraid to take on new activities.”


After graduating from an accredited college program in respiratory care, the respiratory therapist is then expected to take and pass a state licensure examination. Upon graduation, they are also eligible to take a national voluntary examination that, upon passing, leads to the credential, Certified Respiratory Therapist (CRT). If they take two more examinations, they can receive their Registered Respiratory Therapist (RRT) credential. Both the CRT and the RRT are credentialed by the National Board for Respiratory Care.

At most hospitals, the CRT or RRT credential alone does not necessarily determine a higher salary. Instead, salary is based on the therapist’s years of experience and skill level. However, increasing numbers of hospitals throughout the country are starting to require that RTs obtain their RRT. “If that occurs at our institution,” notes Pera, “we will give everyone 3 years to accomplish that, and we’re already giving our staff the heads-up about this possibility.” Currently, about 70% of Pera’s colleagues are registered.

Although only 15 of her 37 respiratory therapists have their RRT, Blansfield believes that all respiratory therapists should have their RRT. She points out that in the past, therapists worked in selected areas based on whether they had their CRT or RRT. “A CRT might have worked the floors only and did oxygen rounds, and the RRTs worked in critical care and the emergency department,” she says. “Now all therapists are expected to be proficient, and are needed, in all areas of respiratory care.”

Many states have begun to formally recognize the importance of the RRT credential. For example, the California Society for Respiratory Care released a White Paper in December 2006, supporting the RRT as the minimum requirement to practice respiratory care in the state of California. As a result of these developments, Pera advises students who rotate through CHOC on internships to obtain their certification and registration immediately following graduation. “They’re going to need them eventually, so it’s better to take them right after graduation,” she says.

Residency Programs

As the scope of the respiratory therapist’s job has expanded in recent years, many institutions have noticed that recent graduates lack the necessary skills needed to perform their jobs well. One solution has been to provide residency or preceptor programs designed to offer additional training to new hires. CHOC’s 4-year-old RCP Residency in Pediatrics has been extremely successful and has attracted attention from many institutions trying to implement similar programs. Patterned after CHOC’s nursing residency program, the 6-month residency program requires new hires who are recent graduates or are transitioning therapists from adult medicine to pediatrics to spend 4 to 6 weeks working in the medical-surgical area and 4 months working in the ICU. In addition, they participate in more than 140 hours of classroom instruction and in other clinical areas of the hospital. Throughout the residency, the RT receives one-on-one clinical training with a specially trained preceptor.

CHOC’s residency program was enhanced this past year when an even stronger focus was placed on mentoring. Since new graduates were looking for advice on how to succeed in the program, particularly related to their relationships with their preceptors and supervisors, Pera wrote a new mentoring program addressing these specific issues. She also trained all the post-residents to become mentors. Now all those in the residency program are assigned to a mentor (who is not their preceptor but is a RT on staff at CHOC) who provides support during this transitional period. This new mentoring component has helped the residents with their decision-making, self-esteem, and emotional maturity.

Although Pera notes that it is hard to say if the program has resulted in increased retention of therapists, she does believe that since it helps them adjust to their new environment, they are more likely to stay.

Anaheim Memorial Medical Center currently does not have a preceptor program, but Blansfield believes it would be a welcome asset. “It has been shown that new grads who are not thoroughly introduced and enmeshed into a department will likely leave their first job out of school within a year,” she says.


As the role of respiratory therapy continues to grow, the most successful students are those who bring passion to their jobs. According to Blansfield, students making the most of their education are those who possess an attitude and desire to learn and excel.

At the same time, Blansfield stresses, hospitals need to take responsibility for respiratory care students participating in internships by helping them become competent therapists. “They are our future; I often tell my students that I want them to be excellent therapists because they may be taking care of me someday.”

Carol Daus is a contributing writer for  RT. For further information, contact [email protected].