"Advanced Practice Respiratory Therapists": coming to your ICU soon?
Probably not for a while, actually
Intensivists should take notice of an emerging accreditation in the alphabet soup of accolades: advanced practice respiratory therapists (APRTs). Respiratory therapist societies have so far failed to move the new role forward meaningfully, but now they’re getting a boost from one of the major US critical care societies.
The Commission on Accreditation for Respiratory Care (CoARC) first devised the APRT certification in 2016—to expand much-needed access to expert RT care to underserved populations, of course.
APRTs would be permitted to perform bronchoscopies, and “are a great asset to the team by adding their expertise in point-of-care ultrasound, line placements, airways, and overall knowledge of pulmonary diseases and disorders,” according to an advocacy statement in Chest Physician in May 2025.
As we’ll see below, to misquote Bill Clinton, that depends on what your definition of are, are.
To achieve APRT status, a person must complete standard respiratory therapist training (a two or four-year associate/baccalaureate degree plus 500-1000 clinical hours), work for one year as an RT, and then complete what CoARC designates as a master’s level degree at an accredited program (about two years as a full-time student). At the only existing training program, APRTs also complete ~1,200 additional clinical hours.
Since 2016, the new accreditation hasn’t gained much traction.
CoARC’s search page only lists Ohio State as its single accredited APRT training program in the US. A university in Charlotte, NC might be establishing one, too.
This has created a chicken-and-egg problem: state legislatures won’t consider creating new licensure for APRTs without the availability of training programs, and educational institutions are hesitant to expand training programs given the lack of a path to licensure:
Licensing and reimbursement issues are both problematic. Licensing occurs at a state level and requires modification of individual state RT practice acts.
The expansion of the role has been going so slowly that in 2023, the American Association of Respiratory Care issued a press release announcing that an APRT was finally hired somewhere in that capacity:
VA Maryland Health Care System (VAMHCS) has taken the concept a big step further, becoming the first organization in the country to create an official APRT role within its system.
In 2025, there were reportedly two APRTs working at that center.
As a federal organization, the VA operates by different rules than other health systems, which may have facilitated the creation of the APRT role there.
Critical Care Societies: Working For You?
One organization that seems quite excited about the expansion of APRTs is the critical care society focused on “chest” medicine.
On its website, it says it “aims to ensure that all integral members of the health care team—physician assistants (PAs), nurse practitioners (NPs), advanced practice respiratory therapists (APRTs), and more—have the resources they need to best serve their patients.”
This is some ambitious language, given that according to state licensing authorities in the US, APRTs do not exist.
A physician editorialist who is a past president of CoARC and a guidelinist for the “chest” critical care society encourages practicing physicians to help APRT advocates change that:
“As physicians, we can and should work with our RT colleagues to support APRT programs. Consider APRTs for APP positions in your practice/institutions. Support the establishment of new programs locally and, if possible, open your practice/facility to clinical rotations for APRT students. Encourage RRTs to consider the APRT as a career path. Finally, support licensure efforts locally and initiatives to allow reimbursement for APRT and RT care.”
As he and other advocates explain, the only agenda here is to relieve critical physician shortages in the US:
As physician shortages continue, APRTs are well-positioned to fill critical gaps, improving both patient care and team efficiency for the future of health care.
The respiratory care advocates have wisely eschewed the zesty approach of lobbyists for the more well-established APPs. Nurse practitioners already have full practice authority in most states. Physician assistants’ society renamed PAs “physician associates” (although it is illegal to use this title in most states) while calling for “Optimal Team Practice,” which is Orwellian doublespeak for eliminating the pesky legal requirement for specific physician supervision or oversight of PAs:
To support Optimal Team Practice, states should: eliminate the legal requirement for a specific relationship between a PA, physician, or any other healthcare provider in order for a PA to practice to the full extent of their education, training and experience; create a separate majority-PA board to regulate PAs or add PAs and physicians who work with PAs to medical or healing arts boards; and authorize PAs to be eligible for direct payment by all public and private insurers.
But keep in mind, it took NP and PA groups 50 years to get that spicy. Team APRT is just getting started.
Sources
https://www.aapa.org/advocacy-central/optimal-team-practice/
https://www.chestphysician.org/advanced-practice-respiratory-therapist-the-new-advanced-practice-provider-2/
https://www.chestnet.org/membership-and-community/career-development/advanced-practice-provider-resources
https://www.aarc.org/news/update-on-the-advanced-practice-respiratory-therapist/
https://www.aarc.org/news/an23-the-advanced-practice-respiratory-therapist-gets-a-big-boost-from-the-va-in-maryland/
https://journal.chestnet.org/article/S0012-3692%2824%2905556-9/fulltext
As an Australian intensivist, I can’t see the need for respiratory therapists on the first place, let alone an Advanced Practice one (or any of the alphabet soup).
Your system makes no sense to me.
Our ICU nurses manage the ventilators just fine in Australia. No need for RT, let alone APRT.
At least there is apparently a certification process involved for this. PAs and NPs in the ER can act independently with no apparent minimum requirements of training/experience whatsoever beyond what just what it takes to become an NP or a PA. And it seems to be only getting worse.
A big driver of this, in my opinion, is the increasing trend towards private equity staffing of ERs, ICUs and hospitalist positions. Their only concern is to do things as cheaply as they possibly can. They could not care less about how well the patients do, as long as they meet the BS minimum "metrics" that they are required to hit. And they have a lot more lobbying power than we do.