82 AMWA Journal / V36 N2 / 2021 / amwa.org Q What are the pros and cons of different types of medical writing (ie, pharmaceutical/biotech, regulatory, managed-care industry, the publishing industry, public relations, lay press, public health, nonprofits, and hospital/university)? A My 20 years as a full-time writer/editor at a research facility attached to a hospital included the prepara- tion of texts for journal publication, talks for meet- ings, editing of books, and management of 13 annual reports. This wide range of experiences led to not only sub- sequent employment at a pharmaceutical company but also access to contacts as a freelancer for clients in 6 countries. Obvious advantages of the full-time situation, of course, are steady salary, benefits (insurance, etc.), and retirement plan, all based on that of a university medical school. Less obvious is the personal growth in skills and opportunities, for exam- ple, company-paid membership in the American Medical Writers Association (AMWA)! The only real disadvantage was time constraints, such as limits on vacation time. Afterward, when a new Director of the institution replaced me and much of the former staff, my subsequent job was as freelance writer for a commercial pharmaceu- tical company. Advantageously, the hourly pay was about 1½ times higher than before. Sometimes I could work from home, and because the company freelancers were a team, I could choose amounts of time off. The disadvantage that surprised me was resentment from my full-time colleagues that I could come and go at will. Finally, I became a roving freelancer. I am still amazed that post docs from early in my full-time research-institution career had advanced to become department heads, particu- larly in China and Japan, and requested editorial services at my choice of cost/hour. However, that situation included the disadvantage of a lag in time of payment, sometimes weeks or months after completion of a project, because the clients preferred to lump costs together. This saga would not be complete without citing the advantageous gift of AMWA membership, which provided professional contacts and teaching opportunities that did and still do underlie my career. — Phyllis Minick Although I have worked for all of the above industries, I will focus here on the area of my most extensive experience: pharmaceutical/biotech companies. All of these companies need medical communication professionals. Many people think that the industry is all about regulatory affairs; it is not. Regulatory affairs work is its own thing, often quite apart from other areas of the industry. For example, departments aside from regulatory affairs that generate work for writers and editors in a pharma/biotech company may include the following • Advertising • Animal sciences • Biological sciences • Clinical research • Corporate communication (public relations) • Corporate or product development • Human resources • Marketing communication • Medical affairs/medical services • Medical communication • Pharmacology • Professional training and education (for non-MD health care professionals) • Sales training and communication • Website management Thus, one could say that medical communication in pharma/biotech includes virtually every aspect of commu- nication, a wide variety of target audiences, and all media. As an employee and later a freelancer, I have worked for all of these departments. For years, I contracted directly with the companies, but today, most companies (the larger ones, at least) prefer to hire outside agencies to handle their writing/editing/ communication needs. For regulatory affairs and clini- cal research projects and reports, a contract research orga- nization is used; for most other communication projects, agencies for MedCom, continuing medical education, adver- tising, or sales training are hired. As a freelancer, some advantages of contracting directly with a company include more intimate contact with the players; the ability to call an expert in the company any time you need to, generally a higher rate, and a feeling of being FREELANCE FOCUS Brian Bass Lori De Milto Phyllis Minick AMWA Journal / V36 N2 / 2021 / amwa.org 83 more immediately connected with the entire process, whether it be medical affairs, marketing, or regulatory affairs. When contracting with an outside agency, you are one step removed; you generally are paid a bit less because one must consider the agency’s need for profit/markup, and you sometimes get paid late (some agencies even ask the freelancer to wait until they have been paid before paying the freelancer). Moreover, depending on the agency, they may be rather paranoid about allowing you to speak directly with the pharma/biotech client, ie, worried that the company might want to hire you directly. So, usually you must sign a “noncompete” agreement in addi- tion to the nondisclosure agreement, and sometimes negotia- tions over the reasonableness of such contracts can become complicated. Regardless of whether you contract with a pharma/biotech company directly or through one of their agencies, there are many advantages to working in this industry, a few of which include • A chance to work on a wide range of projects and/or thera- peutic areas • A plethora of work because of the vast number of such companies and agencies • The opportunity to work with intelligent people and teams • The joy of being able to work on projects that are genuinely interesting and fun (usually when working in MedCom, Marketing, Sales Training) • Interesting travel opportunities paid by the company • Helpful education and training • Generally a higher hourly rate than paid by other industries There are, of course, also some disadvantages as well. Below are some that are mostly related to regulatory affairs (although some of these can been seen as advantages if you enjoy studying and learning): • You must study and understand well the industry as a whole, including the process of proving new drugs, devices, or bio- logicals. • You need to be comfortably familiar with Food and Drug Administration regulations and guidelines in general as well as those relating to the production of specific types of reports and clinical summaries. • You should understand thoroughly the structure and con- tents of an NDA submission (ie, the Common Technical Document), even if you are writing only a specific segment or section of such submission. • You may end up with a team (in-house or in-agency) filled with tension and fear because their bonuses and raises depend on achieving milestones and deadlines demand- ing enough to increase your stress level, to say nothing of the horrendous stress level of the associates with whom you end up working. (In this regard, the agencies do have more burden, because they contract with the companies for extremely high dollars and are liable for errors and omis- sions for which a freelance writer in pharma/biotech should never accept liability.) • You could be working with an inept Project Manager and thus find yourself receiving a “data dump” that takes hours to dissect and organize, leading to “scope creep” that requires you to fill the role of Project Manager, which func- tion should pay more; thus, you may have to renegotiate your fees (I charge ≥30% more for project management and organization than for writing.) • You could find yourself in the uncomfortable position of having to tell the company or agency employees that their “ask” would violate ethics as well as regulations. This could be about a particular “spin” the client wants you to create from clinical study results (eg, in a Clinical Study Report or a journal article), claims a marketing group wishes to make in collateral materials for sales representatives and/or health care professionals, hiding or omitting data that are unflatter- ing to the company, and other questionable practices. Overall, the pluses outweigh the minuses; otherwise, I might have dedicated most of my career to working for nonprofits. — Cathryn D. Evans All types of medical writing have pros and cons. Although you should choose the type of medical writing you do, your background, experience, and writing skill are usually more important than your preferences. For example, regulatory writ- ing pays more than other types of medical writing and is in high demand. But with my journalism degrees and my free- lance experience in health care content marketing and health journalism, I’m not qualified to do regulatory writing. Likewise, many freelancers with clinical or scientific degrees and experience wouldn’t do well at what’s usually con- sidered the more glamorous side of medical writing: public relations, content marketing, most work for patients and the public, and marketing-oriented work for health care profes- sionals. You need very strong writing skills for this type of work. If you work with the right clients like I do, the pay for this type of work is very good but not usually as high as most other types of medical writing. The deadlines are usually much more reasonable than in other types of medical writing, and there are very few meetings or team-based work, which I like. There’s a lot more freelance work in what I call clinical and scientific medical writing (pharmaceutical/biotech, regulatory, etc.) than the type of work I do. That’s good news because most medical writers have clinical or scientific backgrounds. Learn more about different types of medical writing before deciding what might be right for you. Talk to other freelancers FREELANCE FOCUS 84 AMWA Journal / V36 N2 / 2021 / amwa.org about what they like and don’t like about their work. Look for courses, tutorials, and other opportunities to try types of medi- cal writing that seem interesting to you. — Lori De Milto Q Have you offered daily rates to your clients? If so, what are the situations in which daily rates have worked best for you? A I have never offered daily rates to my clients and would never do this. As freelancers, we need to have time for the inevitable revisions that come in when we aren’t expecting them and rush projects for good clients. If we agree to spend a full day doing work for one client, then we either can’t serve our other clients or we have to work too much to be productive. Also, under the Internal Revenue Service standard for inde- pendent contractors, “the payer has the right to control or direct only the result of the work, not what will be done and how it will be done.” A daily rate could violate this standard. It is also very likely to be a problem in any legislation that might be passed, such as the PRO Act. In my freelance business, most days, I do work for 2 or 3 clients. Although I occasionally spend all or most of one day or a few days on work for one client, I would never commit myself to doing this by offering a daily rate. A project rate is a much better way to bill clients. It gives clients the cost of the job for budgeting purposes and gives us the flexibility to do the job when it works best for us as long as we meet the deadline. — Lori De Milto I have offered daily rates for projects requiring travel, eg, my hourly rate times 8.0 hours per day, including flying/travel time, regardless of how many hours are actually “worked” that day. If the client wants more than 8-10 hours of work in a single day, I charge my hourly rate for the hours above that. (I do not charge the time for going out to dinner with the group, unless it is a working dinner.) Otherwise, for most projects I simply charge hourly, although for some clients I will produce something for a fixed fee. — Cathryn D. Evans I don’t think it’s good idea to offer clients daily rates because it ties your value to your time, and there’s a finite amount of money any client will pay for an hour of your time. Worse yet, the thinking behind a daily rate is that the client’s giving you a full day of work, so your day rate should be discounted from your accumulated hourly rate for a day of work. First of all, the client isn’t doing you any favors because tying you up for a day keeps you from being able to juggle the other clients and assignments you have. Second, suggesting you give a client a break for a full day of work implies you don’t otherwise have a full day of work on your plate, because if you did, you’d make more money doing that work instead. Whether you really have a full day of work on your plate or not, your client should believe you do and pay you accordingly. That said, I do use a “daily rate” in my estimates for attend- ing in-person advisory board meetings. Remember when they used to be a thing? My “daily rate” in those circumstances is actually a bit higher than what the client might pay as a cumu- lative hourly rate. They’re taking me away from juggling every- thing else on my plate, and sometimes, those days can be pretty long. The client is paying for my undivided attention, whether I’m actually in the meeting or traveling across the country to get to the meeting and get home. This also helps ensure that cli- ents only take me out of the office when they really need me. — Brian Bass FREELANCE FOCUS General Principles of Word Usage www.amwa.org/online_learning Choose the right word for accuracy and clarity.