Page 2 | To think the BMA have misjudged with another doctor's strike? Thread 2

Locutus2000 · 2025-07-22T10:23:08+00:00

Rolling this over as people still seem to have something to say but no new poll. [[https://www.mumsnet.com/talk/am_i_being_unreasonable/5369651-to-think-the-bma-have-misjudged-with-another-doctors-strike Original post]] ^AIBU to think the BMA have misjudged with another doctor's strike?^ ^Last year they got more than anyone else in the NHS along with an improved deal. Nurses and other AHPs received lower rises.^ ^BMA have just announced another 'resident' doctor strike continuing to chase pay restoration to 2008 levels.^ ^Having just had the major win with changes to IMG prioritisation and the clamp-down on PAs it feels a bit tone-deaf and I can't see Streeting going for it.^

jnh22 · 23/07/2025 10:28

Marchesman · 22/07/2025 22:38

@poetryandwine

That is a lot to address, and I'm probably not the best person to ask. My experience is lengthy, clinical rather than managerial, and anecdotal; although for what it's worth, it is consistent with the data.

I think you are broadly right about costs, seniority, and training because new IMGs are predominantly locally employed (LE). However, I would say that "training" is a misleading term because there is not much difference in learning between these and training posts, if any. The difference is in credentialing and career progression. Costs can be lower because they are not nationally negotiated posts but that is not a reflection of the doctors who fill them or a reason for creating them - IMGs are not employed because they cost less. The posts are set up with specific service requirements in mind and it is helpful to have experienced people filling them.

I think about a third of LE posts are taken by UKGs.

A couple of things may help to put "non-training" posts into perspective. For insight into the job titles:

https://www.kingsfund.org.uk/insight-and-analysis/long-reads/specialty-specialist-locally-employed-doctors-nhs

and for LE numbers, trends, and where they come from:

https://www.gmc-uk.org/about/what-we-do-and-why/data-and-research/the-state-of-medical-education-and-practice-in-the-uk/workforce-report

Performance is measurably declining, for additive reasons, probably starting with the reduction of content in A level sciences, and culminating in reduced clinical exposure in the early years of medical careers. For the effects of reduced science teaching in medical schools, and the lower prior attainment of medical students, see "Exploring UK medical school differences: the MedDifs study of selection, teaching, student and F1 perceptions, postgraduate outcomes and fitness to practise":

https://doi.org/10.1186/s12916-020-01572-3

This is a great post.

C8H10N4O2 · 23/07/2025 11:18

Sevillian · 23/07/2025 10:19

Love the idea that parents get in touch to complain about the grad scheme experience 😂

Oh it seriously happens. Including parents complaining about their child’s room in the 5* hotel accommodation where they are staying for graduate boot camp or complaining about their child’s project assignments/locations. There are also more complaints from the graduates themselves about not getting first pick of roles or not liking a client or working long hours rather than rolling up sleeves and getting stuck in.

The “parent complaint” thing is something which simply didn’t happen before the early 2010s but now happens with every cohort. In terms of age this change generally was just starting with the youngest millennials but is mainly a more recent phenomenon.

C8H10N4O2 · 23/07/2025 11:47

poetryandwine · 23/07/2025 10:19

Fascinating post, @C8H10N4O2

I also genuinely wonder about the relationship between academic knowledge and medical skills.

It seems most UK medical schools now use Problem Based Learning. In my own discipline I see this as more valuable in the later years, when you have a good mental map of core knowledge. Acquiring core knowledge through PBL can obscure fundamental principles and, I think, make things seem unnecessarily complicated.

I think there is some merit in @Marchesman ’s idea that the best candidate via exam gets the job - to be weighed against British economic investment, which is a different discussion - but the exam needs to be curriculum neutral and to assess various qualities, not only book learning. That is a tall order.

The debate of experiential vs fact based learning and assessment vs point in time examination seems to have swung to both extremes over the past 30-40 years.

I remember the tail end of the fashion for self directed learning for spelling dying under a slew of research showing that children (in general) learn to spell and use grammar better from structured and by-rote learning which is then applied experientially. I’ve seen nothing since to suggest that one or the other is absolute rather than a blend of the two. So project work alongside old fashioned book learning still seems to win out.

For my graduates both are needed. There is a huge amount of simple factual knowledge they need to accumulate and which gains meaning in the “mass” but many of the core skills with clients and instincts around solutions can only be developed through hard hours of hands on practice. This is similar in most professions and trades. Medics in the family who trained in the “bad old days” of hundred hour weeks feel the balance toward less hours has inevitably delayed reaching the highest skills (and salaries).

I could say the same - juniors putting in the long hours and taking the difficult projects and locations will gain skills and expertise faster than those who are not willing to put in the hours and who are picky about the work. Ten years down the line the first group will be the fast track partners whilst most of the latter group will have moved to jobs which let them clock off at 5pm but they won’t benefit from involvement in such challenging work (or be earning as much). You can’t have it both ways - that has always been true.

Sevillian · 23/07/2025 13:33

juniors putting in the long hours and taking the difficult projects and locations will gain skills and expertise faster than those who are not willing to put in the hours and who are picky about the work. Ten years down the line the first group will be the fast track partners whilst most of the latter group will have moved to jobs which let them clock off at 5pm but they won’t benefit from involvement in such challenging work (or be earning as much). You can’t have it both ways - that has always been true

Yes, this is exactly the point made by a different poster who talked about 'the more able and more energetic peers' of the resident doctors complaining about having to do the slightest bit 'extra'.

It caused outrage, but as you say C8H10N4O2, it's ever been thus.

Marchesman · 23/07/2025 14:19

poetryandwine · 22/07/2025 23:38

Thank you again, @Marchesman , and for the references.

It is accepted that Maths A Levels, required in my field, got easier for about 30 years and levelled off in the late 90s. (Loughborough did good research on this.) It is plausible something similar happened in other fields and I can imagine the consequences for the study of Medicine.

I am interested in your last link, which I have only skimmed just now, and the statement that a PBL curriculum correlates to worse exam outcomes than a traditional curriculum. This seems obvious, because presumably exams were designed to assess mastery of the traditional curriculum.

But patients surely have an annoying way of refusing to fit nicely into pigeonholes. Does a PBL approach - which I am well aware offers ample opportunity for abuse, to say nothing of genuine mistakes and misunderstandings - have any advantages in Medical education that cannot be captured by the standard exams? Or do you see PBL as essentially worthless even when practised optimally?

I remember "Measuring the Mathematics Problem" (although I can't find the paper now). You had a head-start because diagnostic testing was already in place for engineering, I think. Chemists were also finding the same thing. University mathematics, science and applied science departments adapted, doing some of the work that schools used to do.

Medicine's response has been to do the opposite. (Students find traditonal teaching methods hard, PBL courses score better in student satisfaction surveys, and require less investment on the part of newer universities that have no background in the medical sciences.) This nonsense from a New Zealand paper in the Journal of Medical Education and Curricular Development (Mcnaughton 2016) is pretty typical:

"While research suggests that practice is a mostly tacit collective creation and reshaping of situated knowledge, most health professional practice-based education continues to prioritize individual accumulation of knowledge and skills. Despite this, the process of becoming a person and a professional is a slow, integrated holistic one where affective, bodily, and cognitive learning are affected by the beliefs, attitudes, and values that underpin character and disposition. Thus, practice-based learning may be a “highly personalized and transformative reframing,” changing students’ worldviews.

Increasingly authentic participation in practice-based learning feeds the integrated holistic process of becoming a person and a professional and develops skill, responsiveness, growing expertise, and desirable capacities such as discernment and moral judgment. From an integrated learning perspective, practice is an interpersonal form of knowing, being, and doing."

Postgraduate exams test the ability to retrieve information from memory and analyse new information in clinical contexts. As the paper above shows, PBL is a poorer preparation for this than traditional science based teaching, probably because it does not require analysis, and in particular memorisation practice, to the same extent.

Memory retrieval and analysis are the two fundamental aspects of diagnostic processes. Memory retrieval supports heuristic judgement, it is quick, unconscious and only in certain circumstances engages analytical processing which is slow and effortful. People who have been led to believe that they are experts, rely more on heuristic judgement than analytical. Only when they really are experts, does that work out satisfactorily, most of the time.

But the second thing about PBL graduates, also shown in the McManus paper, is that they overestimate their abilities (and then they have the BMA telling them that they really are "expert clinicians", and their mothers telling them that they are "awsome").

One way or another it is not a pretty picture.

Original poster

Locutus2000 · 23/07/2025 16:20

Spacecowboys · 23/07/2025 09:49

Are PA's actually F1 and F2's ' assistants ' anyway ? My experience is they are not. The PA's that I know are supervised by consultants and registrar level. That's who they are 'assisting' , if it has to be called that.

Show quote history

Yeah, but that spoils the BMA's line.

OP posts:

poetryandwine · 23/07/2025 16:38

Marchesman · 23/07/2025 14:19

I remember "Measuring the Mathematics Problem" (although I can't find the paper now). You had a head-start because diagnostic testing was already in place for engineering, I think. Chemists were also finding the same thing. University mathematics, science and applied science departments adapted, doing some of the work that schools used to do.

Medicine's response has been to do the opposite. (Students find traditonal teaching methods hard, PBL courses score better in student satisfaction surveys, and require less investment on the part of newer universities that have no background in the medical sciences.) This nonsense from a New Zealand paper in the Journal of Medical Education and Curricular Development (Mcnaughton 2016) is pretty typical:

"While research suggests that practice is a mostly tacit collective creation and reshaping of situated knowledge, most health professional practice-based education continues to prioritize individual accumulation of knowledge and skills. Despite this, the process of becoming a person and a professional is a slow, integrated holistic one where affective, bodily, and cognitive learning are affected by the beliefs, attitudes, and values that underpin character and disposition. Thus, practice-based learning may be a “highly personalized and transformative reframing,” changing students’ worldviews.

Increasingly authentic participation in practice-based learning feeds the integrated holistic process of becoming a person and a professional and develops skill, responsiveness, growing expertise, and desirable capacities such as discernment and moral judgment. From an integrated learning perspective, practice is an interpersonal form of knowing, being, and doing."

Postgraduate exams test the ability to retrieve information from memory and analyse new information in clinical contexts. As the paper above shows, PBL is a poorer preparation for this than traditional science based teaching, probably because it does not require analysis, and in particular memorisation practice, to the same extent.

Memory retrieval and analysis are the two fundamental aspects of diagnostic processes. Memory retrieval supports heuristic judgement, it is quick, unconscious and only in certain circumstances engages analytical processing which is slow and effortful. People who have been led to believe that they are experts, rely more on heuristic judgement than analytical. Only when they really are experts, does that work out satisfactorily, most of the time.

But the second thing about PBL graduates, also shown in the McManus paper, is that they overestimate their abilities (and then they have the BMA telling them that they really are "expert clinicians", and their mothers telling them that they are "awsome").

One way or another it is not a pretty picture.

Show quote history

Thank you.

I cannot think of a single thing to say about that quotation. I am not at all sure I understand it, or that I wish to.

I am surprised that PBL in Medicine does not require analysis because PBL can easily incorporate analysis. I was under the impression that doctors were well trained in analytical thinking, so this is disconcerting.

Thank you for the explanation of heuristic v analytical judgment. That’s useful for me, also. I’ve been using such a distinction in my own thinking and in discussions with others, with less precise language, for a long time. Yes, in a nutshell thinking deeply is very effortful.

Marchesman · 23/07/2025 17:40

C8H10N4O2 · 23/07/2025 09:53

@Marchesman I’m interested in the significance of academic standards in making good doctors.

Back in the dark ages when I did “A” levels places for medicine, like Oxbridge, all required an interview before any offer. In practice this meant a good interview could result in a lower grade offer if the candidate was particularly liked. The downside of course was the favouring of “types” or those with connections who received the lower offers.

Then there was a shift toward removing interviews and going solely on grades/school reference. This resulted in higher grade offers as there was no interview elimination round (and of course grades started to inflate). An acquaintance who spent most of her career working in and then running admissions at one of the big London medical schools stated at the time that this resulted in students who were very successful academically but often had shockingly bad communication skills (and a good few horrified to realise anatomy classes involved touching bodies!). At this point most of their pupils still came from private schools or elite grammars but were slightly less white and male.

Wind forward through the 2000s and the private sector has largely priced itself out of its traditional market of doctors, solicitors, bank managers and small business owners. Those pupils now came from the state sector as their parents spent school fee money on tutoring and house moves but they were fundamentally the same cohort, coming with a list of A* but no guarantee of comms skills or interest in actual people. She would have students demanding info in the first weeks of term about networking opportunities with private sector practitioners and often very clear about where the money was speciality wise. I don’t know if its similar at less famous schools. Her view overall was that the overall calibre is less than when she started even though at that time nepotism was rife.

Its always seemed to me that medicine is one of those careers where you need strong academics but also some decent comms skills. The latter may be more significant in, say psychiatry or general practice than from Mr Knob who you meet for 30 seconds before going under anaesthetic to the sound of highland bagpipes, but even in surgery a specialist needs to be able to communicate options and understand the patient’s needs often in limited time.

Something I’ve observed over the last ten years in my own and other industries is what I would loosely describe as a “lack of maturity” in this age group compared to previous cohorts. They need a lot more direction and instruction and seem less able to work independently early on and are less keen on putting the hours in. We have had to completely revamp graduate training to actively teach skills which used to come with the package and even lay on staff to deal with questions from parents not happy about their highly paid graduate child’s “experience"! There are plenty of bright, motivated graduates still and obviously they will be the candidates who succeed long term, but overall the “average” is not what it was. I imagine this effect is felt in medicine as well. I’d love to be able to diagnose the reasons but I can only speculate (but note this is the first generation to experience childhood drowning in SM).

Edited

The communication thing is not grounded in evidence; educational attainment is heritable and correlates positively with emotional intelligence:

Downey L et al. 2008, Emotional intelligence and scholastic achievement in Australian adolescents. Aust J Psychol 60; Mavroveli S, et al. 2011, Trait emotional intelligence influences on academic achievement and school behaviour. Br J Educ Psychol 81(Pt 1); Parker J, et al. 2004, Academic achievement in high school: Does emotional intelligence matter? Pers Individ Dif 37/7; Pope D, et al. 2012, The influence of emotional intelligence on academic progress and achievement in UK university students. Assess Eval High Educ 37/8;

and prosocial behaviour:

Caprara G et al. 2000, Prosocial foundations of children’s academic achievement. Psychol Sci 11/4.

If universities wanted to select on the basis of attainment, they would have to put more effort into it. But on the whole they rate diversity and inclusiveness more highly.

The way this works out in medicine is that medical schools with widely varying academic intakes produce graduates with similar pass rates, undifferentiated by degree class. This persuades the hard of thinking that a transformation has taken place. But the delusion falls apart on contact with reality; medical graduates with lower prior attainment struggle to pass postgraduate examinations and are more likely to be on the receiving end of fitness to practise proceedings.

Since they find work difficult, it is probably fair to assume that they have issues with career progression, higher levels of dissatisfaction, and orange hats.

Marchesman · 23/07/2025 18:10

poetryandwine · 23/07/2025 16:38

Thank you.

I cannot think of a single thing to say about that quotation. I am not at all sure I understand it, or that I wish to.

I am surprised that PBL in Medicine does not require analysis because PBL can easily incorporate analysis. I was under the impression that doctors were well trained in analytical thinking, so this is disconcerting.

Thank you for the explanation of heuristic v analytical judgment. That’s useful for me, also. I’ve been using such a distinction in my own thinking and in discussions with others, with less precise language, for a long time. Yes, in a nutshell thinking deeply is very effortful.

Show quote history

The quote is alarming, I agree,

I'm not claiming that PBL doesn't include analysis, rather that intuitively it would not compare favourably with traditional subject specific teaching across the disciplines of anatomy, physiology, biochemistry, pathology, pharmacology and bacteriology in this respect. In practice this is borne out by postgraduate examination in a range of clinical specialities (as opposed to examination in these named preclinical fields).

Much of the psychology of judgement came out research into the diagnostic process in medicine. A lot of which is cited in D Kahneman, Thinking Fast and Slow which is available through Internet Archive. He won a Nobel Prize for it and that paper is also available online

The Thog Problem is entertaining:

doi.org/10.4236/psych.2021.1212124

Original poster

Locutus2000 · 23/07/2025 18:19

BMA rep on with Andrew Marr. They really seem to think themselves completely detached from public opinion, it's like they think we are too stupid to see their machinations.

OP posts:

RhubarbandCustardYummyYummy · 23/07/2025 18:48

Locutus2000 · 23/07/2025 18:19

BMA rep on with Andrew Marr. They really seem to think themselves completely detached from public opinion, it's like they think we are too stupid to see their machinations.

They didn’t have lots of public support last time but they got a payrise. Rightly so the BMA is after a fair deal for its members.

Sevillian · 23/07/2025 19:49

What they’re after in terms of pay doesn’t seem fair though, and that’s the point.

Marchesman · 23/07/2025 20:01

Is not fair.

Marchesman · 23/07/2025 20:08

Locutus2000 · 23/07/2025 18:19

BMA rep on with Andrew Marr. They really seem to think themselves completely detached from public opinion, it's like they think we are too stupid to see their machinations.

Probably the Dunning-Kruger effect, and greed of course.

(Apologies for additional psychology; I've stopped now.)

poetryandwine · 23/07/2025 20:09

TizerorFizz · 22/07/2025 18:29

@poetryandwine Well not all employers are the same but nearly everyone relies on their staff. So treating them well matters. Business relies on staff being fit enough to work and the health of the nation is important. It’s not old fashioned to believe that being a decent employer gives you an edge and DHs staff had a choice didn’t they? He wasn’t the only employer that wanted their skills. NHs doctors have no other employer until they become consultants and run their own private clinics. That’s part of the frustration I think. No competition for their skills.

I’m really in the Mandelson camp of being relaxed about wealth and the City of London. Its spin off is immense and we have all prospered because it’s done well. I think we are all cross about large salaries and poor performance though - Thames Water springs to mind.

I think the private sector is more efficient in many ways though and strikes less. Zero hours contracts are not everywhere and don’t need to be. However we don’t stop using the firms who have them. Some employees actually like flexibility, like supply teachers. In effect the self employed are the ultimate zero hours contract. No contract - no money.

As you know I’m very much wanting people to have better jobs and better prospects. I just don’t think forcing employers into paying more tax and having more legislation that makes them swerve employing people is the way to go. We shall see what happens. The Cons didn’t help SME business either. My main concern is that business is always seen as uber wealthy, but it’s not. Some pockets of it are but most Governments think it’s everyone. SMEs are the backbone of employment but aren’t getting much help to thrive or grow.

We need growth more than anything. We cannot compete with Ireland (as an example)as a place to do business at the moment. When the public sector employees demand more, the cost is extremely high when you add in pensions and it’s a massive burden for everyone else, which Labour has recognised. So far Labour has not created a climate for business success and neither did the Tories with Brexit wrangling and its aftermath. So where is the money for the nhs coming from? It’s not clear to me other than huge borrowing or higher taxation. I shudder at both and definitely have no political home.

I do know you want people to succeed and that you and possibly DH came up the hard way. I also know that it is unfair to tar the majority of small business and good employers with the reputations of those who have abused government policies. I do blame any government that creates policies allowing that abuse, whether deliberately or not. And successive Tory governments were culpable - without getting a whole lot of growth.

So how do we get it (the growth) and how do we survive and provide an adequate safety net in the meantime?

DH and I don’t have a political home right now, either. I would like some combination if Green + Growth.

Araminta1003 · 23/07/2025 20:12

All the BMA reps I listened to on LBC over the last few months simply seem like they fancied a career as a politician, rather than a career as a doctor serving the public and vulnerable. In which case they should make that jump as we need clever talented motivated people in politics. But they should not be dragging the whole of the NHS into the private sector, somehow somewhere they must understand this to be a big risk?

Araminta1003 · 23/07/2025 20:18

The problem is that Labour did throw whatever little money we do have left to the NHS to get waiting lists down post Covid and these doctors are compromising that. Everyone everywhere has had to take a post Covid hit and they have had it better than most. If they are passionate about their jobs, serving the sick and want the NHS to survive, they would not be striking! Teachers are in a far worse position and so are uni staff and they are plodding on.

poetryandwine · 23/07/2025 20:29

Marchesman · 23/07/2025 18:10

The quote is alarming, I agree,

I'm not claiming that PBL doesn't include analysis, rather that intuitively it would not compare favourably with traditional subject specific teaching across the disciplines of anatomy, physiology, biochemistry, pathology, pharmacology and bacteriology in this respect. In practice this is borne out by postgraduate examination in a range of clinical specialities (as opposed to examination in these named preclinical fields).

Much of the psychology of judgement came out research into the diagnostic process in medicine. A lot of which is cited in D Kahneman, Thinking Fast and Slow which is available through Internet Archive. He won a Nobel Prize for it and that paper is also available online

The Thog Problem is entertaining:

doi.org/10.4236/psych.2021.1212124

Show quote history

If PG clinical examinations bear out what you are saying, that is rather compelling. Why then the switch to PBL, to a degree beyond what most disciplines are using (I think)?

It surely has an auxiliary place in the curriculum, but not a driving one.

The Thog problem is elegant. I think most undergraduates in my School could explain the reasoning clearly to a random high school graduate but I wouldn’t bet vast sums on this.

I will look up DK’s book. As always, thank you for your sources.

poetryandwine · 23/07/2025 21:11

Locutus2000 · 23/07/2025 18:19

BMA rep on with Andrew Marr. They really seem to think themselves completely detached from public opinion, it's like they think we are too stupid to see their machinations.

The BMA leaders doing media both seem to exude a sense of entitlement. I find myself wondering how they got elected, or whether their peers cannot see this?

Carriemac · 24/07/2025 06:58

RhubarbandCustardYummyYummy · 23/07/2025 18:48

They didn’t have lots of public support last time but they got a payrise. Rightly so the BMA is after a fair deal for its members.

Show quote history

Agreed. . Pay them properly and keep your promises Wes .

RhubarbandCustardYummyYummy · 24/07/2025 07:15

poetryandwine · 23/07/2025 21:11

The BMA leaders doing media both seem to exude a sense of entitlement. I find myself wondering how they got elected, or whether their peers cannot see this?

Show quote history

Their ‘peers’ voted for strike action so clearly this isn’t just a few ‘BMA leaders’ - the reality of managing a registrar rota whilst being barely able to afford childcare (much more difficult when forced to move away from family support and having to manage 0700 starts, etc) is a reality for thousands of doctors. We need to pay them enough to actually do the job!

poetryandwine · 24/07/2025 07:35

RhubarbandCustardYummyYummy · 24/07/2025 07:15

Their ‘peers’ voted for strike action so clearly this isn’t just a few ‘BMA leaders’ - the reality of managing a registrar rota whilst being barely able to afford childcare (much more difficult when forced to move away from family support and having to manage 0700 starts, etc) is a reality for thousands of doctors. We need to pay them enough to actually do the job!

Show quote history

Well as shown on the first thread 39.6% of their peers did [vote for strike action]. Not an overwhelming mandate

Spacecowboys · 24/07/2025 07:53

2010 - F1 was £22513 basic. Band 5 nurse entry point £21176 basic.
2024 - F1 £36616 basic, band 5 nurse entry point £29970 basic
2025 if given 29% - F1 46k basic , band 5 entry point nurse £31049 .

Namechangeragin · 24/07/2025 08:13

@TizerorFizz You mention dodging tax and that self employed should pay income tax not dividend tax.

I don’t understand why a plumber, consultant, architect, advisor or shop owner making 55k profit from their ltd and paying 27.75% tax (corp and div combined) on the first 50k then over 52.75% on the next 5k is seen as dodging tax?

A ltd company pays corporation tax 19% on profits under 50k
Sliding scale up to 25% over 250k profit.

Then the director pays tax on dividends.

8.75% for earnings up to £50,270,
33.75% for earnings from £50,271 to £125,140,
and 39.35% for earnings above £125,140.

How is that avoiding tax?

I thought tax dodgers are those working cash in hand or corporates paying tax off shore not in the U.K.

If anything dividend tax when you are working and operating a business which involves risk (not from passive investments) is too high.

We want business owners, if the businesses grow they will employ people.

Sevillian · 24/07/2025 09:28

Pay them properly and keep your promises Wes

He hasn't broken any promises Carriemac. The doctors have become greedy, no doubt in part because Wes Streeting gave them such a big settlement when he came into office and they think he's a relative pushover. It's unconscionable that these same doctors now want even more when the corollary of that is that nurses pay will be squeezed even further. They have childcare issues too, and long difficult rotas very often. Wes Streeting will be well aware that only a minority of resident doctors support the strike and that a majority of consultants don't seem to, never mind the general public. That strengthens his hand no end. He's already making generous offers concerning debt forgiveness etc. Terrible negotiating from the BMA, especially since the debt forgiveness will very definitely benefit the doctors from the least well off family backgrounds who had no financial support other than from SF during their university years.