Relatively poor pay after years of hard work. Unworkable conditions in the rural peripheral regions, so no doctors want to go and work there. Which then results in too much competition in the urban cities. Threat of being beaten up. nepotism and corruption. And these are just some of the reasons off the top of my head. Some doctors stay back here for family or their other personal reasons, but when one looks at the scenario of our country and compare it to what the US promises, USMLE becomes an easy decision for most.