Furthermore, while the bulk of learning to become a qualified, practicing medical doctor actually occurs after medical school — during residency and sometimes fellowship training (which can take anywhere from 3–8+ additional years or 10,000+ hours) — residencies are optional for naturopaths. Let me be clear, I graduated from UCSF medical school and after the 4 years of grueling study and clinical rotations, I was abjectly unqualified to lay a finger on a patient unsupervised without further residency training. Naturopaths, by contrast, can graduate and are allowed to practice independently as primary care providers in 20 states, the District of Columbia, and the US territories of Puerto Rico and the Virgin Islands. In some states, they can obtain a DEA number and prescribe medications. And they are advocating for licensure in more states and for even greater scope of practice.