Respiratory therapy is entering a genuine transition period. The National Board for Respiratory Care has announced that 2026 is the final year of the current two-exam credentialing format, with a single new Respiratory Therapy Examination replacing it starting January 1, 2027. For anyone currently in a respiratory therapy program or considering entering one, this timing matters directly — and it arrives at a moment when California continues to pay respiratory therapists more than any other state in the country.
California Respiratory Therapist Salary Overview
| Metric | Figure |
| California mean annual wage | ~$102,120 |
| National median (for comparison) | ~$80,450 |
| California entry-level (10th percentile) | ~$78,150 |
| California top earners (90th percentile) | ~$138,000 |
| Respiratory therapists employed nationally | ~139,600 |
| National projected job growth | ~12–13% (much faster than average) |
| Credentialing change | Current two-exam format (CRT/RRT) retires end of 2026; single new exam begins 2027 |
Figures reflect Bureau of Labor Statistics Occupational Employment and Wage Statistics data, California state-level, May 2024 release — the most recent official figures available.
Understanding the Credential Shift Before You Commit to a Program Timeline
Under the current system, respiratory therapists earn a Certified Respiratory Therapist (CRT) credential by passing an entry-level exam, then can pursue Registered Respiratory Therapist (RRT) status — the more advanced, generally higher-paying credential — by passing two additional national board exams. Starting in 2027, this entire structure changes to a single new Respiratory Therapy Examination. If you’re currently enrolled in a program or planning to start one soon, your specific graduation timing determines which system you’ll go through, and your school should guide you through the correct exam pathway based on when you finish. It’s worth confirming this timeline directly with your program rather than assuming the current CRT/RRT structure will still apply by the time you graduate.
Why California’s Pay Premium Is So Consistent and Substantial
California has held the position of highest-paying state for respiratory therapists for a long stretch, and the gap over the national median is genuinely large — not the modest 10 to 15 percent premium seen in some other healthcare fields, but a difference that regularly exceeds $20,000 annually compared to lower-paying states. This reflects California’s combination of an aging population with high rates of chronic respiratory conditions like COPD and sleep apnea, continued expansion of ICU capacity following recent years’ healthcare system pressures, and persistent staffing shortages in both rural hospitals and home care settings across the state.
The Bay Area vs. Sacramento Trade-Off Worth Understanding
The Bay Area posts the highest raw pay in the state, but it comes paired with the region’s notoriously high housing costs, meaning a headline salary in San Jose or San Francisco buys meaningfully less in real terms than the same number would in most other parts of California or the country.
Sacramento stands out as the strongest value market for respiratory therapists in California. Pay here runs close to the state’s top tier while housing and general living costs sit considerably below the Bay Area, giving Sacramento-based therapists a stronger real financial outcome than the raw salary comparison alone would suggest.
Los Angeles and San Diego offer large, stable job markets with solid, if more moderate, pay relative to the Bay Area and Sacramento, making them reasonable options for therapists prioritizing job market size and career flexibility over maximizing salary specifically.
Central Valley and other inland metros generally post the lowest pay within the state, though even these areas typically still exceed the national median for this profession given California’s overall wage structure for healthcare roles.
What Actually Determines Where You Land in the Pay Range
Credential level creates a real, persistent pay difference. RRT-credentialed therapists generally out-earn CRT-credentialed peers, reflecting the additional exams and demonstrated competency the advanced credential requires. This gap is a strong argument for pursuing the full RRT pathway rather than stopping at the entry-level CRT credential, particularly for therapists planning a long-term career in the field.
Setting shapes pay considerably. Hospitals employ the largest share of respiratory therapists and consistently report the highest average pay among common settings, reflecting both the acuity of hospital-based respiratory care and the shift and on-call demands hospital positions typically involve.
Overtime and shift differentials meaningfully affect real take-home pay. Median salary figures alone don’t capture what many working respiratory therapists actually earn once night, weekend, and holiday differentials, along with overtime during periods of high patient volume, are factored in.
Experience compounds steadily, though not dramatically, over a career. Respiratory therapists with 20 or more years of experience earn meaningfully more per hour than those just entering the field, but the year-over-year growth is gradual rather than marked by sharp jumps at specific milestones.
Why This Field’s Growth Outlook Remains Genuinely Strong
Respiratory therapist employment is projected to grow considerably faster than the average across all US occupations, driven by durable demographic and healthcare system trends: an aging population with rising rates of chronic respiratory disease, expanded ICU and critical care capacity that continues to need skilled staff, and ongoing shortages particularly acute in rural hospital and home care settings. This combination of strong demand and above-average pay, especially in California specifically, makes respiratory therapy one of the more favorable healthcare careers to enter or advance in right now, credentialing transition notwithstanding.
Is Now a Good Time to Enter This Field Given the 2027 Exam Change?
The upcoming credential transition shouldn’t discourage anyone considering this career — it’s a structural change to how competency is tested and credentialed, not a reflection of declining opportunity in the field. If anything, entering now means benefiting from strong current demand while your program guides you through whichever exam pathway applies to your specific graduation timeline. The more important consideration remains the same as always: confirming with your specific program how the 2027 transition affects your particular cohort’s exam requirements.
FAQs
Q1. Should I try to graduate before the end of 2026 to go through the current CRT/RRT exam system, or does it matter which system I use?
It’s worth discussing directly with your program, since your specific exam pathway depends on your graduation timing rather than personal choice, and schools are actively guiding students through whichever system applies to them. There’s no indication that one system produces a stronger credential than the other for employment purposes — this is primarily an exam format and administrative change rather than a shift in what the credential represents.
Q2. Is it worth pursuing the RRT credential instead of stopping at CRT, given the additional exams required?
Generally yes — RRT-credentialed therapists consistently earn more than CRT-only therapists, and the additional exams represent a relatively modest additional time investment compared to the pay difference over a career. For anyone planning to stay in respiratory therapy long-term, pursuing the full RRT pathway is typically worth the extra effort.
Q3. Is Sacramento really a better financial choice than the Bay Area for respiratory therapists, given the Bay Area’s higher headline pay?
For therapists prioritizing real financial outcomes over the highest nominal salary, Sacramento often provides a stronger overall result, since it combines pay close to the state’s top tier with meaningfully lower housing costs than the Bay Area. It’s worth running the specific cost-of-living comparison for your situation rather than assuming the highest posted salary automatically represents the best choice.
Q4. Does working night shifts and holidays really add up to meaningful additional income for respiratory therapists in California?
Yes, often substantially — shift differentials and overtime during high-volume periods can meaningfully boost total annual income beyond the base median figures, which only reflect straight-time pay. Given hospital-based respiratory care’s constant staffing needs around the clock, therapists willing to work less popular shifts frequently see a real, noticeable increase in their effective annual earnings.