CBRC vs NBRC: respiratory therapy exams

CBRC vs NBRC is the comparison a respiratory therapy graduate makes when deciding which side of the border to practise on, and this year it is also the comparison an American graduate makes with their own exam, because the National Board for Respiratory Care is retiring the examination structure it has used for decades. What follows sets the Canadian and American routes side by side, then explains what changes in 2027 and who it affects.

The two systems side by side

The structural difference is where clinical judgment is examined. Canada folds case-based reasoning into the single examination, with the second part made entirely of cases. The United States separated it: the TMC tests breadth, and the CSE is a dedicated four-hour test of decision-making through evolving patient scenarios. That separation is what ends in 2027.

What the NBRC is changing in 2027

From January 2027 the TMC and CSE are replaced by one Respiratory Therapy Examination. The NBRC's published specification is 185 multiple-choice items, 160 of them scored and 25 pretest, over a four-hour limit, at $360 for new applicants and $300 for repeat applicants. The examination is assembled in two sections, one for breadth of knowledge and one for depth of clinical judgment, and it keeps the two cut scores: the low cut score earns the CRT credential and the high cut score earns the RRT.

The NBRC's stated reason is to reduce barriers for graduates entering the profession while holding the standard, and it notes a consequence of the old structure that the new one removes: a candidate who stopped at the CRT could bypass a deep clinical judgment assessment altogether. Under the single examination every candidate is assessed on clinical judgment, whichever credential they earn.

The transition rules

• Candidates who pass the TMC at the high cut score by December 31, 2026 remain eligible for the CSE, which is scheduled to end on December 31, 2027.
• Those same candidates may instead take the new examination after January 1, 2027.
• Under the current structure a candidate may attempt the TMC or the CSE three times, after which a minimum of 120 days must pass between further attempts.

For a student graduating in spring 2027 the change is simply the examination they will sit. For a student graduating in late 2026 it is a decision: sit the TMC before the year ends and keep the CSE route open, or wait and take the single examination. Neither is obviously better, but the second means preparing for a format with no prior candidates.

The Canadian examination in more detail

The Canadian examination is built on the National Competency Profile set by the National Alliance of Respiratory Therapy Regulatory Bodies, and every question is reviewed in English and French before it enters the bank. The candidate manual describes roughly 200 questions in two parts, each with a suggested two and a half hours and a thirty-minute break between them, delivered on computer at proctored sites. Questions are four-option multiple choice, and the second part consists of case studies only. The pass mark is set by a bookmark standard-setting study rather than a fixed percentage.

The consequence of one sitting a year is that the examination is a single event in a graduate's calendar rather than something to reschedule. It also means that a graduate who is not ready has to wait a year, which is a stronger argument for rehearsal under examination conditions than anything in the American system. The full Canadian route, including program accreditation, is at how to become a respiratory therapist in canada.

Moving between the two systems

Neither examination is accepted in place of the other. A Canadian RRT who wants to practise in the United States applies to the NBRC, which lists holding the CSRT's RRT credential among its eligibility routes for the TMC, so the Canadian credential opens the door to the American examinations rather than replacing them. An American CRT or RRT moving to Canada applies to the provincial regulator, which decides whether the education is substantially equivalent before allowing the candidate to sit the national examination; Health Professionals Testing Canada requires that approval from the regulating authority before a foreign-trained applicant may register.

The timing consequence is asymmetric. An American graduate can sit the NBRC examinations within weeks of a Canadian regulator's decision, because they are scheduled through a testing vendor. A Canadian-bound candidate who misses the single annual session waits a year, and the assessment of foreign education has to be complete before that session's registration closes. Anyone planning the move north should count backwards from the examination date, not forwards from arrival.

Regulation on each side of the border

Passing the examination is not the same as being allowed to practise. In Canada eight provinces have a respiratory therapy regulator: Alberta, Saskatchewan, Manitoba, Ontario, Quebec, New Brunswick, Nova Scotia, and Newfoundland and Labrador, each with its own college or order. Where a province has no regulator, the Canadian Society of Respiratory Therapists is the reference body. In the United States licensure is a state matter, set on top of the NBRC credential, and the requirements differ from one state to the next. The jurisdiction-by-jurisdiction map is at respiratory therapist.

The demand behind the examinations

Respiratory therapy is one of the professions where training capacity, not applicant interest, sets the size of the workforce. A July 2026 report from the MassINC Policy Center and the Massachusetts Health and Hospital Association examined six allied health occupations, respiratory therapists among them, and found that the state's community college programs receive around 4,500 applicants for roughly 2,200 seats. The same survey found acute and long-term care organisations reporting a combined 232 million dollars a year in temporary agency spending across those six occupations, which the report extrapolates to more than 450 million. That is one state, but the mechanism is general: the cost of the seats a program cannot open is paid later, by hospitals, at agency rates. The wider placement constraint is examined at allied health clinical placement shortage.

Preparing for either examination

The two systems reward the same underlying skill, which is deciding what to do next for a patient whose condition is changing, and they test it in different containers. Three points of preparation carry across.

• Practise cases as sequences, not as isolated questions. The Canadian second part and the American CSE both present a patient over time, and the error that fails candidates is answering each step without carrying the previous findings forward.
• Rehearse under the clock. Two and a half hours per part in Canada and four hours for the CSE are long enough that pacing, not knowledge, decides the last quarter of the examination.
• Know which examination you are sitting. A Canadian graduate considering the United States needs the NBRC route, and from 2027 that route is a different examination from the one any current RRT sat.