Alison McIntosh successfully operated as a freelance medical writer for 14 years and gave up the ‘flexible lifestyle’ of a selfemployed freelance medical writer to become a full time employee. She has joined a growing band of ‘decentralised’ office workers and has become an employee of ICON Clinical Research, a full service, world-wide clinical research organisation (CRO). She has stepped from one end of the medical writing spectrum to the other in terms of working arrangement and organisational structure. The skills needed to work for a large CRO align well with those of a freelance medical writer. Whilst major benefits of joining a large organisation have included colleagues to share the workload, and well defined department structures, new company jargon together with the number of standard operating procedures have been a more challenging experience.