The stars had to align in a very precise pattern for Robert to become a rheumatologist. First, because his training was interrupted by military service, he had time to reconsider his choice of general internal medicine. Then, he was struck by how sad the general internists he met all seemed, which gave Robert another reason to rethink that specialty. Robert felt strongly that he should experience work in a research lab so he would not later regret never having done it. Going into general internal medicine would have meant no time in a research lab. Finally, Dorothy was given a pediatric rheumatology fellowship position at the University of Michigan where he would do a rheumatology fellowship. Dr. William N. Kelley asked him "what I thought of rheumatology. It turns out Dr. Irving Fox, a rheumatologist on the faculty, had just received a new grant with a post doc position. So after interviewing, it was decided that I would do 1 year of research as a rheumatology fellow.
"... I did struggle in the lab at first but found I really like rheumatology. So in April, I met with Irv and requested a second year of fellowship and told him I wanted to become an academic rheumatologist, but with a clinical, not research, position. Only 2 weeks later, I was sitting in a small library with graph paper and three different colored pencils plotting the results of an experiment (we did not have computers then). The red line went up and the blue line went down and that was my "eureka moment." Those results told me the definite answer to a question we were asking and told me what the next step was. I experienced what others had told me about, about what it is like when you know something for the first time, even if it is trivial, and you are the only one in the world to know it. But I was hooked on research. It was definitely an acquired taste," Dr. Wortmann said.
When asked to identify the largest changes in rheumatology since he was certified in 1979, Dr. Robert Wortmann cited a long list: "We have gone from salicylates and gold to methotrexate and biologics for rheumatoid arthritis. Because of these advances and earlier diagnosis, we hardly ever see crippling disease and patients in wheelchairs. I don’t know if trainees today ever see patients with swan neck or boutonniere deformities of their hands.
"The life expectancy of knee replacements has improved from 5 to 25 years (thank goodness)! Wegener’s granulomatosis has gone from a universally and rapidly fatal disease to very treatable one, and scleroderma renal crisis is almost unheard of. Fibromyalgia has become epidemic. The percentage of adults in this country with hyperuricemia has risen from 5% to 21.4% with a proportionate increase in the number of patients with gout, now 8.3 million. One of my interests is metabolic myopathies. In 1979, only 4 had been described; now we know of more than 25. The "Primer on the Rheumatic Diseases" has quadrupled in size."
Over the course of her career, Dr. Dorothy Wortmann has seen her specialty blossom: "Pediatric rheumatology was in its infancy as I started. There were not many of us, we had few medications, and there were little if any data on which to base treatment. We didn’t have a textbook until 1992 with the "Textbook of Pediatric Rheumatology," which is now in its sixth edition. At about the same time, we were a recognized as a subspecialty in pediatrics and the first Pediatric Rheumatology Board exam was given. The Pediatric Collaborative Study Group was first and now we have CARRA and PRINTO as well. We have objective outcome measures, data on which to base our decision for treatment and an array of more effective medications."