V39 N2 / 2024 

©2024 American Medical Writers Association. All rights reserved.  
ISSN 2163-5315

AMWAJournal.org     16

ABSTRACT
A high-performing medical writing team begins and ends 
with talented writers, editors, and leaders who understand 
their mission and their business. A panel of writers com-
prising the authors convened virtually on October 28, 2021, 
at the American Medical Writers Association national con-
ference to discuss this topic. The topics of value proposi-
tion and business models; communication, leadership, and 
corporate responsibility; and financial acumen are reprised 
in this 3-part series. The series also includes thoughts from 
the authors looking to the future of the business of medical 
writing, including what we can do in the medical writing 
community to introduce these topics earlier in the medi-
cal writing career path. This Part 3 manuscript focuses on 
financial acumen. 

A high-performing medical writing team begins and ends 
with talented writers, editors, and leaders who understand 
their mission and their business: the value proposition, the 
finances that drive strategy and decision-making, the finan-
cial goals, and effective communication.
 A panel of writers comprising the authors convened  
virtually on October 28, 2021, at the American Medical 
Writers Association (AMWA) national conference to discuss 
this theme.1 
 The topics of value proposition and business models2; 
communication, leadership, and corporate responsibility3;  
and financial acumen are reprised in this three-part series, 
along with thoughts from the authors looking to the future 
of the business of medical writing, including what we can do 
in the medical writing community to introduce these topics 
earlier in the medical writing career path. This Part 3 man-
uscript focuses on the importance of financial acumen and 
mastering fundamental financial concepts. 
 The authors’ collective experience comprises the follow-
ing medical writing work environments:

• Freelance business
• Small business/vendor

• Department leadership of small- to mid-size biotech 
company and large-sized pharmaceutical company

 The moderator’s (Joan Affleck - JA) prompt is provided 
for each topic, followed by each perspective on the topic. In 
some cases, text from the session has been paraphrased for 
optimal clarity in this medium. 

FINANCIALS 
JA: When we talk about success in business, a lot of times 
we talk—or think—about the money. I want to spend a few 
minutes to talk about money: cash flow, balance sheets, 
quarterly earnings, budget forecasting. These are terms 
that many medical writers are not really familiar with 
and don’t have a lot of practice with. So I would love to 
hear how you learned about those terms and practices and 
became comfortable with the financial aspects of business. 

DD: Well, I don’t know if I ever became comfortable with 
them, but I certainly had to figure out how to work with 
them. It was really out of necessity when I started my busi-
ness many years ago. And it was really to understand what 
made the whole thing a business—what defined a busi-
ness legally and practically, how did you have to report 
your earnings, your obligations under tax requirements, 
and so on. There was a lot of education that had to happen 
because I came to [business] as a scientist from the bench; I 
didn’t have business training. I learned from the ground up, 
by my bootstraps, found a good accountant, and certainly 
asked many, many questions. At the end of the day it really 
comes down to—especially in the freelance setting—under-
standing (1) what you can do in a unit of time and how to 
translate that into successful project work for a client main-
taining quality at a certain cycle time and (2) how fast can 
you do the work well and maintain things to keep it profit-
able. We are providing a business product in a business set-
ting, and the product is a written document; so, you need to 
think about that all at once—you can’t really separate one 
from the other and hope for long-term success. 

Joan Affleck, MBA; Dominic De Bellis, PhD1; Brian Bass, MWC2; and Jeanette M. Towles, MA, RAC-Drugs3 /  
1Merck & Co, Inc, Rahway, NJ; 2Bass Global, Inc, Fort Myers, FL; 3Synterex, Inc, Dedham, MA

PART 3 IN A 3-PART SERIES

The Business of Medical Writing: Financial Acumen  

TOPICAL FEATURE

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AMWAJournal.org     17The Business of Medical Writing: Financial Acumen  

BB: I’d love to say I learned from the best. But really, I 
learned from the worst. I always learn more from my mis-
takes than I do from my successes; I analyze them deeper to 
understand what went wrong. I have a long history, before 
working for myself, of working for small companies—and 
I worked for great people, brilliant people, nice people, 
talented people, but none of them knew how to run busi-
nesses. As I sit here today, out of all the companies I have 
worked for in my life, only two are still in business, and 
I’m glad to say that one of them is mine. What I’ve done is 
pay attention to the mistakes that people made that led to 
downfalls. And one of the big ones that I see—and I think 
this crosses the board from freelance to people who work on 
staff—is [continuity]: the direct link between how much you 
get done, how well you do it, and your ability to be able to 
keep doing it and generate revenue (Figure 1).

 When you work for a company, it can be a little easier to 
lose track of this direct link between your productivity and 
your ability to get a paycheck because there are so many 
other people factoring into that ability to get the paycheck. 
As freelancers, especially if you work independently, if you 
don’t work today, you don’t get paid tomorrow; if you take a 
week off, it makes things a little bit harder next month when 
you don’t have the same amount of revenue coming in. But 
where I see a challenge on the staff side is that many staff 
people lose that continuity. A lot of companies that have 
been my clients in the past have ultimately not succeeded 
because they spent so much more time working on projects 
than they had been scoped for. Yes, those projects turned 
out to be absolutely fantastic, but the company wasn’t able 
to keep paying salaries at the end of the year or a couple of 
years down the line; it does have a ripple effect. 

JA: Even in our shop it does. Jeanette, how about for you? 

JT: My first exposure was right before I started the business. 
I was in-house, happily writing, and my boss stepped away 
from the department, unfortunately. So I pretty quickly 
found myself in a position where I basically had no context 
for the financial aspects of the department; I had to step in 
and be able to produce things like quarterly reforecasting 
and an annual budget, and lots of other fun things, so it was 
really a feet-to-the-fire moment for me. I learned a lot in 
that process but also enough to know that it’s not really the 
best way for people to learn that type of material; gradual 
exposure to it in a context where you can really understand 
how it connects to the day-to-day would be a much-pre-
ferred approach. So, fast-forward a few years to starting my 
own business and having to look at the balance sheet and all 
that: I really tried to take some of those concepts and infuse 
them into my operational team so that they understand. Just 
as an example, we have to look at time sheets, and anything 
that is marked as nonbillable, we need to actually make sure 
is nonbillable and check on why—or if that is something 
that is supposed to be billed to a project. Because, as Brian 
mentioned, if you don’t check on those things, something 
that should be profitable can become unprofitable quickly, 
so you want your staff to really understand what that’s 
about—that you really do need to look at things at that level 
of detail in order to be responsible about the company. 

DD: Jeanette, that’s a key point: in your company, you’ve 
decided proactively to really break down that barrier and 
share that information across your staff. Brian, you have to 
do that by design—that’s what you follow to really manage 
the company’s activities day-to-day. For me, we have some 
visibility into those things, but the company has a whole 
finance department that handles that information, and they 
don’t often tell us the specific things that might or might not 
be helpful for us to know. It’s hard sometimes in-house to 
see clearly without [such] visibility, so that’s a challenge we 
have. Overall, we know what makes for a good product, and 
we know what makes for efficiencies—and we hope that 
indirectly we are making a positive impact. 

JA: I think one of the key areas in talking about produc-
tivity and utilization is to get our staff comfortable with 
those terms and that it’s not a threat to talk about those 
things; it’s part of business because we have to be good 
financial stewards and good stewards of our people—our 
resources—as well. Any tips on how to do that? Dom, you 
mentioned being transparent about it. (Figure 2)

DD: Yes, knowing what questions to ask about financial 
aspects is important, and I’m not sure if all medical writ-
ers ever really have the opportunity to figure out what they 

Figure 1. Linkage between productivity and revenue.

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AMWAJournal.org     18The Business of Medical Writing: Financial Acumen  

don’t know [through discussion]. They’d have to think  
about that and say, “I can balance my checkbook, but if 
I’m writing a protocol, what does it really cost if we have to 
amend the document?” Understanding what those data are 
and what goes into the operational aspects of a clinical study, 

for example, are critical. Just 

thinking about [a clinical study] 

as a commodity really brings 

home the business component. 

We have to remind the writers 

to put their pens down and look 

around them and say, “We’re in 

business, too.”

BB: I spend a lot of time mentoring freelancers on the busi-
ness aspects of freelancing. One of the biggest and most 
frequent questions that comes up is around estimating proj-
ects. I work on a project basis rather than on an hourly-rate 
basis, which is what drives that question. But it’s interesting 
when someone comes to me with project parameters and 
they want to know how much they should charge. To me, 
that’s not the question at all, and I get back to them with 
about 20 questions on the minuscule aspects of the project 
and the deliverable in order to wrap my mind around put-
ting together that estimate. This is a muscle that freelanc-
ers need to constantly strengthen. When the questions you 
need to get answered to put an estimate together come nat-
urally, that’s when you’re able to really estimate on a reli-
able and accurate basis. 

JT: I’ve noticed a continuity between the freelance and the 
in-house experience [in terms of] the concept of accruals. 
Not only, prospectively, How much do you think this will 
take? But now that you’ve done it, Where are we with this? 
Sometimes there is a disconnect with the finance depart-
ment not really understanding how much of the project is 
actually complete. Especially if the company is in a posi-
tion where they are about to do an IPO or something like 
that, they might be tracking things down to the dollar, and 
so sometimes on both sides of the fence, I’ve had to pro-
vide information about things like, if the project is a unit, 
it’s one-third done, and here’s where I think we will be next 
month. This requires communication with whoever you are 
partnering with, whether that’s in-house staff or a vendor, 
to know exactly where things are and if any difficulties have 
come up, in order to be accurate. 

JA: I love that comment, Jeanette, and the idea of using 
these muscles in the corporate setting because, as Dom 
said, there are often other people—other departments—
that have this as their primary work, [but] for writers, it’s 
like a whole different sport. We haven’t used those mus-
cles at all! So it’s a real call to action and embedding in 
our practice the idea of forecasting but then looking at the 
accruals. Great comments! 

LOOKING TOWARD THE FUTURE 
In Part 1 of this 3-part series, the authors discussed how this 
panel was an initial dialogue meant to “kick off a broader 
discussion of the many aspects of business leadership as 
it applies to our work as medical communicators.”1 The 
authors concluded that having a comprehensive business 
curriculum—namely, a pathway whereby medical writers 
can readily learn the skills needed to demonstrate leader-
ship while also participating in decision-making activities 

Figure 2. Utilization means ensuring the expected amount of 
revenue is generated compared with all available billable hours 
in a time period while accounting for indirect and direct over-
head costs.4

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AMWAJournal.org     19The Business of Medical Writing: Financial Acumen  

earlier in their careers—would benefit the writer toward the 
goal of developing a strategic mindset while learning funda-
mental business strategies and skills.2 
 In today’s dynamic business environment, the ability for 
employees at all levels to interpret key financial indicators 
is more crucial than ever. Financial snapshots such as quar-
terly earnings reports provide invaluable insight into the 
health and trajectory of an organization. When employees 
have financial literacy baked into their corporate culture, 
they can not only grasp the current financial standing of the 
company but also gain a clearer vision of its future prospects 
and challenges.5 This understanding empowers employees 
to make informed decisions in their respective roles, align 
their strategies with their company’s objectives, contribute 
more effectively to the company’s overall success, and, as 
a result, fuel their own success as well. Fostering financial 
literacy across all tiers of the organization can be a game-
changer in steering its direction and ensuring sustained 
growth. An employee’s ability to see the bigger financial 
picture can also be a boon to their career development, no 
matter what career path the employee ultimately chooses. 
 An important component of financial literacy within the 
corporate culture is fostering an understanding of where 
and how revenue is generated, and developing a clear pic-
ture of how each employee contributes to that process. 
Cash flow represents the lifeblood of a business,6 and a 
healthy business should have enough cash flow to meet its 
expenses, repay debts, reward investors, and fuel growth. 
For a freelancer or small medical writing business owner, 
the goal would be to balance necessary nonbillable tasks 
with billable ones. Additionally, after a certain point,  
freelancers and small business owners may bring on ven-
dors or partners to help maximize what they do best, which 
is generating revenue based on subject matter expertise 
and getting customers to return for repeat business.3 For 
employees whose work contributes directly to the bottom 
line, this metric is otherwise known as utilization4  
(Figure 2)—in other words, a calculation that ensures a 
resource is contributing the expected amount of revenue 
compared with all available billable hours in a time period 
while accounting for their indirect and direct overhead 
costs. Examining this metric can help a freelancer or ser-
vice provider understand whether they are charging enough 
for services, whether there is an appropriate number of staff, 
and whether the desired profit margin will be achieved. For 
an in-house writer, the concept of utilization differs slightly 
from the freelance or service provider scenario in that they 
are not directly generating revenue. However, most people in 
industry would agree that medical writers essentially sit in a 
place of revenue enablement (for example, medicinal prod-
ucts cannot get to market without documentation support for 
key clinical and regulatory stakeholders, and clinicians need 
to know about the results of clinical studies to determine 

a new treatment’s place within the current armamentar-
ium). Thus, utilization can be considered in a similar light 
in terms of how much time medical writing employees are 
investing on documents directly 
in support of revenue-enabling 
activities compared with purely 
administrative overhead. It all 
boils down to understanding 
what you can do with a unit of 
time and maximizing that con-
tribution no matter the business 
model to help the company 
gain a competitive edge.2,3

 The importance of understanding business concepts 
for all medical writers cannot be overstated, as it enables 
them to make informed decisions and drive their organiza-
tions toward success even in the face of volatility or change. 
Pairing training in general accounting and financial con-
cepts such as accounting methodology (accrual vs cash 
methods), financial software, budgeting, forecasting, inter-
preting financial statements, and bookkeeping, and specific 
training on the revenue generation, cash flow, and other  
relevant financial overview of the company, with a goal 
toward a broad culture of financial literacy, can help all 
medical writers (freelance and staff alike) allocate resources 
efficiently, assess performance, and ensure the sustainabil-
ity of their businesses or departments.

Author declarations and disclosures: D. De Bellis is employed 
by Merck & Co, Inc, and is a shareholder. J. Affleck, B. Bass, and  
J. Towles note no commercial associations that may pose a con-
flict of interest in relation to this article.

Author contact: jtowles@synterex.com

References 
1.  AMWA 2021 Medical Writing & Communication Conference 

registration brochure. AMWA; 2021. Accessed July 26, 2022. 
https://cdn.ymaws.com/www.amwa.org/resource/resmgr/
conference/2021/2021amwa_conf_program_june15.pdf 

2.  Affleck J, De Bellis D, Bass B, Towles J. The business of 
medical writing: understanding the value proposition and 
successful business models [part 1 in a 3-part series]. AMWA J. 
2023;38(2):21-25. https://doi.org/10.55752/amwa.2023.197

3.  Affleck J, De Bellis D, Bass B, Towles J. The business of medical 
writing: communication, leadership, and corporate responsibility 
[part 2 in a 3-part series]. AMWA J. 2023;38(4):20-26. https://doi.
org/10.55752/amwa.2023.273

4.  Smartsheet. Everything you need to know about utilization rates. 
Accessed July 26, 2023. https://www.smartsheet.com/content/
what-is-utilization-rate-formula  

5.  Webb S. Why you should make financial literacy part 
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forbesfinancecouncil/2020/09/18/why-you-should-
make-financial-literacy-part-of-your-company-
culture/?sh=6b0b85aa2c39 

6.  Thangavelu P. Why cash management is key to business success. 
Investopedia. Updated December 26, 2022. Accessed July 26, 
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