You dont get rich in academic medicine, unless you are a neurosurgeon or orthopod. It wasnt the amount of money, but the complexity of having some state income, some service related pay, VA Federal pay, and spouse pay, but the state, city, income and school and property taxes made it too complicated for me, and I used to be pretty good in math, but calculus doesnt help in tax returns. I had no trouble figuring out my taxes in North Carolina, that lulled me into the mistake that I could do it in an afternoon in NY in early April. After the first allowed delay of finalizing the returns had passed( with prepayment of estimated tax), and then the impending point of no further delay, and threatening letters from the IRS, I threw myself on the mercy of the accountants, as I could probably pay taxes working, rather than visiting Club Fed.
Years later the accountants told me I had one of the most complicated returns they had worked on!
I had already concluded that for my tax problem, no solution existed, which is good enough in mathematics, but not taxes.
They real advantage here is the low cost of living, as apparently, 100 plus inches of snow keeps the property values low. It is hard to find a home within two miles of a medical center/University, where a starting junior faculty member can afford to buy a home, with a great public school system. Many of my cohorts commute 2 or more hours a day. I can cross country ski to work in 20 minutes, or 5 minutes on my bike with snow tires. We have all season Cats!