Following surveys in 2003, 2007, 2010 and 2012, the fifth EMWA Freelance Business Survey was conducted in 2015. 181 respondents, most based in Europe, completed the survey. The findings indicate that freelance medical writing and related activities continue to offer a varied and potentially lucrative business opportunity. The responses received indicate a wide range of types of work and client, from niche opportunities to more traditional medical writing activities. In addition, freelancing offers unique flexibility, as indicated by the range of hours worked. Chargeable rates have been stable since the first survey in 2003, and it appears that the freelance environment remains a healthy place within which to operate.