The freelance medical writing landscape has evolved in recent years, with more market demand for competent medical writers who can work on a project basis. In January 2023, the European Medical Writers Association’s (EMWA) Freelance Business Group launched the 7th EMWA Freelance Business Survey (FBS), with the aim of analysing current trends in freelancing. Our analysis includes previously unpublished data from the 6th EMWA FBS to report changing behaviours in freelancing from 2018 to 2023. The 2023 FBS had a total of 223 respondents, more than in 2018 (n=142), most of whom were generally younger and less experienced (<5 years). Hourly rates charged were on average higher than those reported by respondents in 2018. Median hourly rates across all services provided was €82.2 and increased with years of experience. Networking and business advertising saw a decline in 2023, and word of mouth was considered the greatest influencer in gaining new business. Professional development efforts have taken a shift to personal research and online courses. Data presented here highlights the most current predominantly European trends in freelance medical writing. Medical Writing. 2023;32(2):56–70. https://doi.org/10.56012/worg5056