The freelance market and what a practice competes on
The freelance medical-writing market includes different clients, services and business models. Surveys describe the practices operating within it, while fluctuations in demand and competition affect the work available and the value a practice offers.
Surveyed practices
EMWA's freelance surveys had 63 respondents in 2003, 101 in 2007, 130 in 2010, 123 in 2012 and 181 in 2015. The 2018–2019 round had 142 respondents and January 2023's round had 223. In 2012, 68% were based in Europe and worked for clients in other countries, 26% worked only for clients in their European country of residence and 6% lived outside Europe but worked for European clients. Nearly three-quarters therefore worked across borders. Of those answering the employment question, 67% worked full-time freelance, 26% part-time and 8% combined company employment and freelancing; 85% were EMWA members. Among 118 answering about hours, 47% averaged 30 or fewer weekly, 47% worked 31–50 and 6% exceeded 50, a pattern similar to the preceding surveys.
In 2015, 115 respondents (63.5%) were based in Europe with clients in different countries, 54 (29.8%) worked only in their European home country and 12 (6.6%) were based outside Europe with European clients. Among 176 answering about employment, 110 (62.5%) were full-time freelances, 57 (32.4%) part-time and nine (5.1%) combined employment and freelance work. The weekly hours reported by 175 respondents, based on typical workloads over three years, were:
| Weekly hours | Respondents (%) |
|---|---|
| 1–10 | 8.6 |
| 11–20 | 16.6 |
| 21–30 | 28.6 |
| 31–40 | 30.3 |
| 41–50 | 13.1 |
| More than 50 | 2.9 |
Fewer than half worked more than 30 hours, although almost two-thirds described themselves as full-time, suggesting that freelancing may offer favourable work–life balance compared with an employed week of about 40 hours.
The 2023 respondents were predominantly women (77.6%, compared with 78.9% in 2018) and based in Europe (78.5%, compared with 79.6%). Their reported experience categories were less than one year (12.6%), one to five years (32.7%), six to ten (18.4%), eleven to fifteen (11.2%) and more than fifteen (13.0%), with 12.1% not answering. These categories did not distinguish medical-writing experience from freelance experience. The age bands in 2023 were under 39 (30.5%), 40–49 (31.8%), 50–59 (25.6%) and 60 or older (10.8%), with 1.8% preferring not to say.
Around 30% were based in the UK in both 2018 and 2023; Germany's share fell from 16.9% to 11.2% and France's from 9.2% to 6.3%, while Italy's rose from 1.4% to 8.1% and Portugal's from 2.1% to 5.4%. India accounted for three respondents (2.1%) in 2018 and 25 (11.3%) in 2023, while the US accounted for 21 (14.8%) and eight (3.6%), respectively. The 2018 survey's distribution through AMWA contributed to its larger American share. In 2023, 66.4% described themselves as wholly freelance and 17.0% as combining freelance work with contract work or study, with 3.6% reporting another status and 13.0% not answering. Typical weekly hours were under 20 for 24.2%, 20–40 for 52.5% and over 40 for 10.8%, with 12.6% not answering.
A separate survey of 175 freelances in April–May 2018 found that 73 had more than ten years' freelance experience, 30 had under two and 17% had five to ten years. The most common principal specialisms among 173 answering were publications (26%, 44), regulatory writing (15%, 25) and continuing medical education (12%, 21), with 53 types of work named. Among 171 answering about challenges, finding clients accounted for 32% (54), making enough money 20% (35), marketing 19% (33) and taxes 16% (28), with no other challenge exceeding 1%. Finding enough clients remained a concern even in this experienced group.
The 2016 Tools of the Trade survey of 323 freelances found about 30% had more than ten years' experience; its question allowed the top one to three work areas, with 60% naming scientific publications, 39% continuing education, 23% regulatory documents, 22% patient education and 14% sales training.
Services and documents
The mean activity shares reported by 75 respondents in 2007, 122 in 2010 and 105 in 2012 were:
| Activity | 2007 (%) | 2010 (%) | 2012 (%) |
|---|---|---|---|
| Writing | 62 | 55 | 61 |
| Editing | 14 | 14 | 15 |
| Translation | 6 | 11 | 6 |
| Consultancy | 3 | 8 | 6 |
| Training events | 4 | 4 | 4 |
| Quality control | 4 | 4 | 3 |
| Proofreading | 3 | 3 | 3 |
| Electronic publishing | 1 | 1 | 0.4 |
| Other | 2 | 2 | 2 |
The document mix among 101 respondents in 2012 was:
| Document | Mean share of work (%) |
|---|---|
| Scientific journal and scientific press articles | 36 |
| Non-clinical and clinical testing documentation, including documents contributing to drug or device approval | 34 |
| Marketing and congress materials and proceedings | 7 |
| Presentations | 6 |
| Educational materials for patients and health professionals, including audiovisual media | 4 |
| Medical and scientific textbooks | 2 |
| Training documentation | 2 |
| Websites | 2 |
| Post-marketing documentation, including safety updates and pharmacovigilance | 2 |
| Standard operating procedures | 1 |
| Product information | 1 |
| Consultancy documentation | 1 |
| Device user manuals | 0.1 |
| Other | 2 |
In 2015, writing accounted for 62.3% of work, editing 19.1% and consultancy 10.3%, with quality control, translation, proofreading and training also providing opportunities. The document mix among 148 respondents, averaged over typical workloads in the preceding three years, was:
| Document | Mean share of work (%) |
|---|---|
| Scientific journal and scientific press articles | 32.2 |
| Non-protocol supporting documentation for non-clinical and clinical study reports, and the reports themselves | 9.8 |
| Marketing and congress materials and proceedings | 9.7 |
| Presentations | 9.7 |
| Regulatory submission summaries, including clinical overviews, efficacy and safety summaries and prescribing information | 8.1 |
| Educational materials for patients and health professionals, including audiovisual media | 6.8 |
| Preparatory trial documents, including protocols and supporting documentation | 5.3 |
| Marketing product information, including monographs | 3.9 |
| Consultancy documentation | 2.2 |
| Training documentation | 2.0 |
| Other regulatory documents, including variations, safety updates, risk management plans, annual reports and authority responses | 1.9 |
| Websites | 1.9 |
| Medical and scientific textbooks | 1.5 |
| Standard operating procedures | 1.0 |
| Device user manuals | 0.3 |
| Other | 5.4 |
Slightly more than half of work fell under medical communications and publications and about a quarter under regulatory writing. Classifying respondents by time spent on specified document types placed 56.4% mainly in medical communications and 22.1% mainly in regulatory work, with those whose two totals were within 10% classed as doing both.
In 2023, services provided and time devoted to each were reported as follows:
| Service | Respondents providing it (%) | Mean share of time ± SD (range), % |
|---|---|---|
| Writing | 81.6 | 67.9 ±26.4 (5–100) |
| Proofreading and editing | 51.1 | 19.8 ±19.4 (0–100) |
| Quality control | 38.1 | 14.1 ±13.6 (0–80) |
| Consultancy, including training | 35.0 | 17.9 ±18.1 (0–90) |
| Translation | 23.8 | 9.8 ±14.1 (0–50) |
| Electronic publishing | 13.5 | 7.2 ±15.6 (0–80) |
| Other | 16.6 | 22.2 ±23.8 (0–90) |
Thirty-three respondents did not answer the service question. Other services included strategy, quality and general management, marketing and sales, advisory and educational roles, graphic design, medical and social media monitoring, statistics and volunteer work. Additional services named in 2018 included clinical development consulting, indexing, coaching and mentoring, data checking, epidemiologic research, event organisation and client liaison, health technology assessment, interpreting, peer review, post-editing machine translation, publication planning and safety. Service frequencies in 2018 and 2023 are not directly comparable because respondents selected three options in 2018 but all that applied in 2023.
The documents delivered in 2023 were:
| Document | Respondents (%) |
|---|---|
| Journal manuscripts | 58.3 |
| Conference abstracts, posters and slide kits | 54.3 |
| Patient and health-professional education and training | 43.5 |
| Websites and online articles | 33.6 |
| Investigator brochures, study protocols and reports | 30.0 |
| Marketing materials | 29.6 |
| Conference proceedings | 21.1 |
| Medical-device and biologics regulatory documents | 18.4 |
| Regulatory summaries, CTD sections, SmPCs and product inserts | 17.9 |
| Market access and health economics and outcomes research | 10.3 |
| Standard operating procedures and user manuals | 9.0 |
| Medical and scientific textbooks | 7.6 |
| Other regulatory documents | 6.7 |
| Other documents | 11.2 |
Twenty-seven respondents did not answer the document question. Other documents in 2023 included advisory-board and strategy documents, plain-language materials, event management, grant proposals, internal communications, regulatory defence and briefing, training, social media, policy reports, digital assets, scientific platforms, ethics-committee documents and theses. Additional examples named in 2018 included health technology assessment submissions, translations, academic and consulting documents, clinical study reports, drug specification booklets, professional guidelines, global value and health-economic dossiers, informed consent forms, internal reports, device manuals, press releases, public databases such as ClinicalTrials.gov, safety narratives, study-guide apps, non-regulatory study reports, reimbursement submissions, internal company documents and conference agendas.
Clients
The 2012 client mix among 107 respondents was:
| Work provider | Mean share of work (%) |
|---|---|
| Pharmaceutical companies | 28 |
| Medical communications agencies | 24 |
| Academic institutions or academia-based individuals | 16 |
| Contract research organisations | 10 |
| Publishers | 5 |
| Medical-device companies | 4 |
| Non-profit organisations | 3 |
| Biotechnology companies | 3 |
| Work placement agencies | 1 |
| Other | 6 |
The 2015 client mix among 157 respondents, based on typical workloads over three years, was:
| Work provider | Mean share of work (%) |
|---|---|
| Medical communications agencies | 43.2 |
| Research-based pharmaceutical companies | 27.9 |
| Contract research organisations | 13.4 |
| Academic institutions or academia-based individuals | 12.2 |
| Publishers | 10.3 |
| Medical-device companies | 6.9 |
| Medical-writing companies | 3.9 |
| Biotechnology companies | 3.5 |
| Non-profit organisations | 3.0 |
| Generic-drug companies | 2.8 |
| Work placement agencies | 2.4 |
| Other sponsors, including investigator-led research groups | 1.9 |
| Other | 3.6 |
In 2023, main clients were reported as follows:
| Client | Respondents (%) |
|---|---|
| Medical communications agencies | 43.5 |
| Pharmaceutical companies | 31.8 |
| Biotechnology, veterinary or medical-device companies | 19.7 |
| Medical-writing companies | 18.4 |
| Contract research organisations | 15.7 |
| Academic institutions | 14.3 |
| Publishers, including health journalism | 9.0 |
| Non-profit organisations | 8.1 |
| Other | 4.0 |
| No response | 29.6 |
Other clients included hospitals, translation agencies, field-research companies, individual scientists, clinicians and statisticians, consulting agencies, the food industry and in-vitro diagnostics manufacturers. The growth of medical-writing companies and relative decline of pharmaceutical companies as main clients were interpreted as signs of pharmaceutical companies externalising writing through consulting companies.
Opportunities and competition
In 2015, one view of the market was that total medical-communications investment remained relatively constant while spending moved between continuing medical education, sales training and manuscripts; a diverse portfolio could therefore help a freelance adapt to changing opportunities. Reported opportunities included crowdfunding presentations for research or medical expenses, though these were not routine income sources, and blog posts, white papers and webinars for health information technology, mobile health and revenue-cycle management businesses. Plain-language trial-result summaries and clearer patient information delivered through electronic health records were also anticipated as growth areas.
In 2016, a medical editor reported a full workload since 1997 apart from the economic downturn beginning in August 2008; a company subcontracting editing found its medical education, communications and advertising clients relied on professional editors and judged opportunities at least equal to those for writers. Geography could also provide a niche: in 2015, a Polish writing, translation and statistics business found that major pharmaceutical companies generally kept medical writers in headquarters abroad rather than Poland, while the range of services was an asset.
The worldwide number of freelance medical writers and the division of outsourced work between agencies and freelances were not known in 2023. In 2016, EU-wide data specifically on freelance medical professionals were also lacking. Growing demand from pharmaceutical, biotechnology and medical-technology companies and from contract research organisations and writing agencies was seen in 2023 as increasing engagement with freelances. Reported opportunities extended across experience levels, medical communications and regulatory work, and full-time and hybrid working regardless of location.
Competitive advantage can rest on customer-defined value such as price, speed or convenience, perceived enhanced value and uniqueness. A 2017 assessment considered UK writers unlikely to compete with India on price and suggested efficiency, convenience, ambitious timelines and working across time zones as alternatives. In that 2017 assessment, competition was expected to harm businesses that failed either to provide good service or convince clients of its quality, while uncertainty was not a reason to stop planning growth and diversification.
Slow periods and the post-pandemic market
Businesses cycle through different levels of productivity and profit, and an individual slow period can raise doubts about client satisfaction, advertising and expertise even when clients previously praised the work. In late 2022, a recession was expected to be harder on freelances because pandemic-era entry had increased competition while inflation raised pressure on incomes; health care was considered more stable than most industries and likely to soften the impact on medical writers and editors.
By 2023, reduced demand for COVID-related services, biotechnology layoffs, pharmaceutical restructuring and cost cutting, geopolitical uncertainty and delayed non-COVID trials contributed to slower industry growth. The January 2024 #MedComms Freelancing Barometer received 550 worldwide responses about 2023 and found lower demand for freelances; nearly half reported year-end revenue below expectations because of fewer projects despite maintaining rates.
The October 2023 AMWA conference discussion among seasoned freelances found many had experienced an unusually slow year, but not everyone slowed or remained slow throughout it, and regulatory writers there reported no slowdown. Suggested causes were pharmaceutical belt-tightening reducing agency work, reduced funding stalling communications initiatives, rising interest rates discouraging venture investment and general uncertainty. Experienced participants regarded fluctuations as familiar and considered 2023 an opportunity for additional time off before 2024.
A July 2024 webinar and informal freelance survey presented a mixed picture: some reported normal workloads, while others had faced unusual challenges since 2022 that continued into 2024. Reported seasonal troughs were deeper, even busy freelances turned down less work, and previously stable practices experienced feast or famine. Some lost contracts because unchanged rates were considered too high or saw clients reduce hours at the expense of quality; projects could fail to materialise or expand without a larger budget. More new competitors were perceived, but no quantified comparison of freelance numbers supported that impression.
Some reported fewer requests from agencies, contract research organisations and former clients in both medical communications and regulatory work, with demands for in-house working and quieter recruiter and LinkedIn activity. Previous contacts could no longer supply work because of agency restrictions on freelances, closures or restructuring, and some contacts had themselves become freelance. Experienced writers unused to marketing found business development and new technology daunting while newer competitors offered those skills at lower rates. Some moved to employed or hybrid roles for security, income concerns or exhaustion from trying to win and retain clients.