Goteni in the meaning of doctors of Tenyakuryo indicates, except Tenyaku no kami (the head of tenyakuryo) which was an honorary position, the doctors who were indeed engaged in treatment of emperors.
典薬寮医師という意味での御典医は、名誉職であった典薬頭を除き、実際に天皇の治療に携わる医師のことを指した。