Only 48 of the more than 65,000 school leavers in NSW achieved the 99.95 ATAR needed to gain entry into medicine at the University of Sydney.
Yet the course is so popular that even some of those students could miss out on one of the 30 places offered to undergraduates each year.
Nationwide, fewer than 20 per cent of students who applied for medicine were offered a place last year, lower than any other field.
Last year, 12,433 students applied for medical studies courses nationally, an increase of almost a quarter since 2009, federal government statistics show.
By the numbers, prospective students had a better chance of getting into law, with offers made to 67 per cent of students who applied, and engineering, for which 85 per cent who applied received an offer of a place.
At the University of NSW, more than 3500 students applied for the 148 standard entry places for medicine last year.
While the minimum Australian Tertiary Admissions Rank for eligibility is 96, the university says the median ATAR among students accepted is always more than 99.6.
This year the university will have 280 undergraduate places available, of which about 208 will go to domestic students.
Sydney University medical school dean Bruce Robinson said, normally, about 90 per cent of the 30 places offered to school leavers went to NSW students. And it was ''absolutely the case'' that some 99.95 students missed out because of oversupply.
Top students might also fail to make the cut because they were not deemed suitable during the interview process.
''One reason is that they're so immature that they don't even realise that they're meant to indicate that they want to become doctors in the long run,'' he said. ''There was a student today [Thursday] who clearly failed to acknowledge that he wanted to be anything other than a musician.''
Professor Robinson said the university preferred students who were more mature, which was why its medicine degree was a graduate program. In addition to the 30 undergraduate students accepted, the school takes on 200 postgraduate and 70 international students.
''We feel as though our students really do want to be there,'' he said.
''It's not something that they're doing because they got a high mark. It's something they are doing because they really are choosing a vocation.''
The University of Newcastle, which has a minimum ATAR of 94.30 for its medicine degree, received more than 3000 applicants for its 170 positions last year.
Students had until midnight on Saturday to finalise their preferences for the main round of offers, which are released on January 16.
Leaving his decision until the last possible moment, prospective medicine student David Wei Hu, 18, decided to list the University of Sydney as his first preference.
He was one of six students from James Ruse Agricultural High School to receive a 99.95 ATAR last year. He said all of them had applied to study medicine.
The story Best HSC marks fail to guarantee place in medicine courses first appeared on The Sydney Morning Herald.