I'm working on a 4th axis build right now, and I plan to post a video of the build soon. One of the final steps will be to turn a faceplate with a tenon to fit into the back of my 3-jaw chuck. I plan to do that on my mill with the faceplate mounted on the 4th axis and turning, slowly, while cutting the face with an end mill. I could do that step on the metal lathe but doing it on the 4th axis itself should minimize the runout. I did turn it close to final dimensions on the lathe though, so that I will be taking just a very shallow cut in the final step. I think this will work well, but it is a somewhat special case because I'm only cutting 2 surfaces parallel and perpendicular to the axis of the end mill, versus a more general turning application where Tony's comments about scalloped cuts would apply.
Another thing to consider in any such application is that some kinds of milling cuts will put considerable torque on the 4th axis. I'm building mine with an ultra-low-backlash harmonic drive and a 45:1 reduction ratio so it should be pretty beefy, but I expect that the more common belt-driven 4th axes are much less rigid and they have a much lower reduction ratio so the driving and holding torque will be much lower. And the worm gear designs have more torque but tend to have significant backlash unless they're adjusted tightly, which wears the gears faster. I don't think it would be a problem as long as you keep the cutting torque opposite the rotation of the axis, i.e. non-climb-cutting. Otherwise it would tend to jerk the work forward into the cutter if there's any appreciable backlash in the system.