I'm so happy to have found this thread!! Another single female academic medicine faculty member here, and in Manhattan also. I can tell from your post you aren't at my institution, but I can relate to what you're writing here, for sure!
Congrats on your decision to pursue adoption. I considered that several years back and went partway through the process. I found that US programs wouldn't accept singles. Then the international programs shut down because of a UN action. I was too old at that point to start over. I hope this isn't going to be a barrier for you.
I was also hesitant because of the NYC academic medicine salary problem. You are actually doing very well. For most of my career I was earning half your salary until very recently. I'm still not earning quite as much as you are, and I'm now an associate professor with tenure and an established research career. And lest you think it's just me...a male colleague of mine at Harvard was paid even less than I was when we first started.
I completely agree with Kidstache and others that your pay would be greatly increased, and cost of living decreased, if you left NYC and went to someplace like Michigan or Cincinnati. If you'd be as happy there as you are now, then definitely consider it. But, don't be dissuaded if you have other reasons to be in NYC. I happen to very much enjoy living here and also have family & friends in the area that I really don't want to move away from. Support networks are worth a lot too. I can and have made it work here financially, and you can too. I'm currently less than 3 years away from being financially independent. This doesn't mean I'll stop working, but it means I won't wake up in the middle of the night in a sweat about not getting my next grant funded, and also that I don't have to stay on the rat race wheel any longer than I want to. The reality, unfortunately, is that despite the many rewards inherent in an academic medicine career, regulations and administrative requirements have gotten so onerous that it dominates my daily working life, to the detriment of doing actual science or patient care. I don't know when I'll be ready to call it quits, but I think it will happen well before age 65.
Here are a few suggestions based on my experience: 1) Make use of the NIH loan repayment program, if you do clinical research. 2) Find a lower cost neighborhood that works for your lifestyle, if you haven't already. 3) If you can, try to buy a large one bedroom and add a partition to create a second bedroom. Many people do this. 4) Continue to live like a resident. You can enjoy plenty of happy hours, good restaurant meals, and cultural events, while keeping a lid on costs. Beware of fancy bars where you can drop $50 in a heartbeat, take advantage of NY Restaurant Week, and get last minute TKTS and opera tickets. I'm also part of a network of "house concerts", or chamber music evenings at my coop's lounge space or a colleague's apartment for minimal cost.
Best of luck!!!!!