CRT vs RRT: Which Credential, Which Exam, and Which Pays More
The CRT and RRT are the two NBRC credentials that determine whether you can practice as a respiratory therapist and how much you’ll earn doing it. Both come from the same exam pipeline but represent different competency levels, and the pay gap between them is often larger than candidates realize. This guide explains how the credentials work, how the exams are scored, what to study, and why almost every U.S. hospital now hires RRT over CRT.
What CRT and RRT Mean
The Certified Respiratory Therapist (CRT) is the entry-level NBRC credential. It signals that you can safely perform basic respiratory care across general patient settings. The Registered Respiratory Therapist (RRT) is the advanced credential and signals additional clinical reasoning, particularly around critical care, complex ventilator management, and case-based decision making. The credentials sit in a stepwise relationship: passing the TMC at the lower cut score gives you the CRT; passing it at the higher cut score qualifies you to take the CSE, and passing the CSE earns the RRT.
The Therapist Multiple-Choice (TMC) Exam
The TMC is a 160-item multiple-choice exam (140 scored, 20 pretest). It is computer-delivered through Pearson VUE and runs three hours. The content blueprint is roughly: patient data evaluation and recommendations (~31%), troubleshooting and quality control (~20%), and initiating, conducting, and modifying interventions (~49%). The exam uses two cut scores: the lower one awards CRT; the higher one awards CRT plus eligibility for the CSE. Plan to clear the higher cut on the first attempt—repeated attempts are allowed but slow your hiring.
The Clinical Simulation Examination (CSE)
The CSE is a four-hour case-based exam consisting of approximately 22 simulated patient scenarios. Each scenario unfolds across information-gathering and decision-making sections that branch based on your responses. Unlike multiple choice, the CSE evaluates clinical reasoning sequence: ordering the right test before the right intervention matters, not just the final answer. The pass mark is set per administration via standardized scoring. Most candidates report the CSE as harder than the TMC and benefit from at least 60 days of dedicated case-based prep.
How the Pay Gap Works
National data and job postings consistently show a hospital wage premium of $2–$6 per hour for RRT over CRT in equivalent roles, plus access to ICU, NICU, and PICU positions that almost universally require RRT. Over a full-time year, that translates to $4,000–$12,000 in base pay alone. Add the indirect access to specialty credentials (ACCS, NPS, SDS), all of which require RRT eligibility, and the lifetime gap is meaningful. See current state-level wage data on our salary directory.
Study Plan: 8–12 Weeks of Focused Prep
The strongest results come from a structured plan: weeks 1–4 cover content review by blueprint section using the AARC content outline; weeks 5–8 are full-length TMC simulations under timed conditions, with item-by-item review of misses; weeks 9–12 transition to CSE branching scenarios using a case-based prep platform. Aim for 80%+ on practice TMCs before scheduling. For the CSE, the rule of thumb is that you should be able to articulate why you’d order each test or intervention, not just which to choose.
Top Study Resources
Most candidates use a combination of Kettering Review courses (in-person or live online), Lindsey Jones home study, the AARC official content outline and practice exams, and Comprehensive Respiratory Therapy Exam Prep textbooks. Free resources include the NBRC self-assessment exams (worth the $50 fee) and the AARC podcast study series. The single highest-yield resource is taking at least three full-length timed practice TMCs and three to four practice CSE branching cases before exam day.
Re-Take Strategy If You Don’t Pass
The NBRC currently allows three attempts within a 12-month window. If you fall short, the score report breaks performance down by content area—use it. Don’t simply re-study everything; target the lowest-scoring sections. Most second-attempt candidates pass with another 60–90 days of focused work on weak areas. Beyond three attempts, NBRC requires evidence of additional education before retesting.
Should You Stop at CRT?
Almost no. The marginal effort to extend study from CRT to CSE-eligible scoring on the TMC is small compared with the lifetime financial and career impact. The only candidates who reasonably stop at CRT are those working in non-acute outpatient settings where RRT is not required and where they have no plans to advance into ICU or specialty roles. For everyone else, plan from day one to finish at RRT. Pair this credential with a strong job search using our RT resume tips and salary negotiation guide.
Timing Strategy: Take TMC and CSE Together
The most efficient credentialing path schedules the TMC and CSE within 30-60 days of each other while content is fresh. Sit for the TMC immediately after passing your final NBRC self-assessment with 80%+ scores. Schedule the CSE 4-6 weeks later — long enough to do dedicated case-based prep, short enough that mechanical ventilation, ABG interpretation, and pharmacology fundamentals haven't decayed. Many candidates who pass the TMC then delay the CSE for 6-12 months because they've already started working as CRTs; this strategy nearly always extends total credentialing time and reduces first-attempt CSE pass rates because work demands compete with study time.
Maintaining the Credential
NBRC requires Continuing Competency Program (CCP) participation for credential maintenance. RRTs renew every 5 years through one of two pathways: 30 hours of approved CE plus 4 NBRC continuing competency assessments, or by retaking the credentialing exam. Most working RTs choose the CE pathway since it integrates with hospital in-service traitraining. Track your CE hours from year one — scrambling to assemble 30 hours in the final months of your renewal cycle is a common avoidable stressor.
Frequently Asked Questions
CRT vs RRT difference? CRT entry-level credential. RRT advanced credential demonstrating deeper competency. Most career RTs pursue RRT.
Pay difference? RRT typically commands $5,000-$15,000+ premium over CRT.
How to upgrade CRT to RRT? Pass NBRC TMC exam (becomes CRT) plus Clinical Simulation Examination (becomes RRT).
Which credential do employers prefer? Most hospitals strongly prefer RRT. Some hire CRT entry-level then require RRT achievement within 1-2 years.
Specialty credentials beyond RRT? NPS (Neonatal/Pediatric), ACCS (Adult Critical Care), SDS (Sleep), CPFT (Pulmonary Function).
Renewal requirements? NBRC requires 30 CE units every 5 years plus competency assessment.
Best path for new RT? Pursue RRT plus first specialty credential within 3 years.
How to Decide Between These Paths
The right path for any specific respiratory therapist depends on personal fit factors that no comparison guide can substitute for. Three concrete steps to test your fit: shadow practitioners in each path you're considering for at least one full day each, talk to 2-3 working professionals about their actual day-to-day work and career arc, and run a 5-year financial projection for each path under realistic assumptions about your specific situation. The candidates who do this groundwork before committing have far stronger long-term career satisfaction than those who choose based on online research alone.
Switching Between Paths Mid-Career
Mid-career transitions between respiratory therapist specialty paths are common and increasingly viable. Most transitions require: 6-18 months of additional training or certification specific to the new path, mentorship from a practitioner already in the target path, and acceptance of a temporary pay reset during the transition (typically 6-24 months at lower pay before reaching parity with the new specialty). Plan these transitions deliberately rather than reactively — the strongest mid-career switches are made when you have financial cushion and a clear understanding of why the new path will be better than the current one.
Where can I verify these salary figures? See U.S. Bureau of Labor Statistics OEWS data for Respiratory Therapists for current state, metro, and industry pay statistics.