After almost 50 years in practice, Dr Gabor Major reflects on the breakthroughs that reshaped rheumatoid arthritis care and the workforce crisis still facing the specialty.
Newcastle rheumatologist Dr Gabor Major has watched the speciality undergo a therapeutic revolution over nearly five decades and says today’s patients face a vastly different future than previous generations.
Dr Major has been awarded a Medal of the Order of Australia (OAM) in the General Division in the King’s Birthday Honours.
The Hunter-based specialist, who was notified of the honour several months ago but required to keep it confidential, said the recognition had initially come as a surprise.
While he knows who nominated him, he is keeping their identity close to his chest. He celebrated the honour quietly with a small family celebration on the long weekend.
Dr Major received his OAM for service to rheumatology. The director of Rheumatology at the Hunter New England Health Service was among hundreds of Aussies to receive a gong in the King’s Birthday Honours.
He is well recognised as playing an integral role in the development of rheumatology as a specialty in Australia. In 1984 he established the Rheumatology Unit at the Royal Newcastle Hospital and has been a clinical lecturer and now conjoint senior lecturer at the University of Newcastle’s School of Medicine and Public Health since 1978. 
Dr Major has been a member of the Australian Rheumatology Association for more than five decades and is a former executive member, including as head of NSW/ACT. He is also involved with the Australian Scleroderma Interest Group and a list of professional societies and organisations, including Royal Australasian College of Physicians, the American College of Rheumatology, the Australian New Zealand Bone and Mineral Society, the Arthritis Foundation of Australia, the Scleroderma/Lupus Support Society, the Lupus Association, the Australian Medical Association, the Australian Salaried Medical Officers Federation, and the Medical Indemnity Protection Society. 
Reflecting on his career since entering rheumatology in the late 1970s, Dr Major said the specialty had changed “enormously”.
“It’s been revolutionary,” he told Rheumatology Republic.
“When I was a registrar, a patient with rheumatoid arthritis really had a poor outlook. There was a high risk that over the years they would get progressively worse, lose function, become disabled, and become dependent on others. Today it’s a lot different.”
Dr Major said the management of rheumatoid arthritis before the 1990s was dominated by a cautious “go low and go slow” treatment approach, largely because available therapies carried substantial risks and offered limited benefits.
The introduction of more effective disease-modifying therapies, including methotrexate, marked the beginning of a major shift in clinical practice.
“There was a revolution in the way we were thinking about it,” he said.
“Rather than the pyramid approach, we would go in early and go hard. That became the new slogan.”
At the same time, advances in immunology paved the way for biologic therapies, with growing understanding of molecular targets such as tumour necrosis factor-alpha helping transform treatment outcomes.
The result, according to Dr Major, has been a complete change in prognosis for newly diagnosed patients.
“If somebody comes in with a new diagnosis of rheumatoid arthritis, I can confidently say to them that this is something we can manage and treat,” he told Rheumatology Republic.
“There’s nothing at all like what happened to previous generations of patients.”
While rheumatology therapeutics have advanced dramatically, Dr Major said building comprehensive services in regional New South Wales had been equally important.
A longstanding focus has been ensuring patients in the Hunter region can access specialist care across the full spectrum of rheumatic disease, including paediatric rheumatology.
He highlighted the development of a transition clinic linking paediatric and adult services, helping adolescents transition into adult care while gradually taking responsibility for managing their own health.
Dr Major also pointed to fracture liaison services as one of the achievements he is most proud of.
The service identifies patients presenting with minimal-trauma fractures and intervenes to reduce the risk of subsequent fractures.
“We’ve been running that for a few years and were among the first to demonstrate that having a clinic actually reduces the refracture rate substantially,” he said.
“The percentage drop in refracture rates is of a similar magnitude to what you can achieve with recognised osteoporosis treatments.”
Despite the progress made in patient care, Dr Major remains concerned about workforce shortages, particularly outside metropolitan centres.
“We need more rheumatologists,” he said.
“We’re seriously short of what we need. Just looking at the waiting list to get an appointment, it’s ridiculous.”
He said paediatric rheumatology remained especially stretched, and there was a desperate need to import the training pipeline in New South Wales.
For adult rheumatology, he believed greater investment in public hospital and outpatient services was needed to create more opportunities for specialists to work within the public system.
“Many people really cannot afford to attend private practice,” he said.
Asked what he considered the highlight of his career, Dr Major did not point to awards, research or clinical milestones.
“I suppose the main highlight is the collegiality of the people I work with and have worked with over the years,” he said.
“I’ve always found that a great source of satisfaction.”
Retirement, meanwhile, was not yet on the horizon.
“No, not at the moment, I really enjoy my work,” Dr Major said.
