I've been milling PCBs for about 10 years, although I do very few these days now that China is so cheap and quick. I prefer to spend extra time going over the design, and printing out scale copies to check footprints and mechanical clearances.
I started for the occasional prototype and to help teach other people PCB design. It was especially useful for clients who needed a prototype yesterday, or to make up non-working mechanical samples for the industrial designers. But I also use my CNC milling machines and CNC routers for machining other parts (aluminium and plastic) so the cost was easily justified. I couldn't justify the Othermill myself, but I know people who have them.
You can certainly get very good results, even making double sided boards and solder resist. I have made many double sided PCBs down to 0.5mm pitch and 0402 parts, but it is quite time consuming. One of the big benefits over "home" etching is that the drills and PCB outline are precisely cut. So precise that I would do double sided PCBs as two single sided half thickness boards, and then solder them back to back. I also use those tiny copper rivets if I can afford the space for the larger vias needed. One key thing is making sure the PCB material is as flat as possible, as you only want to make very shallow cuts, and any dips or bows will ruin part of the PCB.
See this Hackaday article from today for an example of what can be achieved if you have everything properly set up (a big task)
https://hackaday.com/2018/12/02/cnc-machine-most-satisfyingly-mills-double-sided-pcbs/I've never had a board come off the mill looking that good - they generally need some work with fine steel wool and maybe a scalpel - but I also don't tend to buy the really expensive cutters. I also never would have thought of milling off the resist layer - that needs very good Z precision.