The medical writing industry is evolving. With a growing demand for competent and experienced medical writers in both the product industry (pharmaceutical, biotechnology-related, and medical technology-related) and service providers (clinical research organisations and medical writing agencies), there is an increased engagement with freelance medical writers. Freelance medical writers and medical writing agencies work in a symbiotic relationship. Here, we offer you the medical writing agency perspective by sharing some of the best practices and processes that are adopted by medical writing agencies to strengthen their engagement with freelance medical writers. We finish with some tips from the freelance medical writer’s perspective about how to appropriately engage with an agency. It can work both ways, so getting the balance just right is key to a successful collaboration. Medical Writing. 2023;32(2):48–52. https://doi.org/10.56012/pydv4748