Automatic evaluation of open-ended question answering in specialized domains remains challenging mainly because it relies on manual annotations from domain experts. In this work, we assess the ability of several large language models (LLMs), including closed-access (GPT-5.1, Gemini-2.5-Pro), open-source general-purpose (Qwen-80B), and biomedical domain-adapted models (MedGemma-27B, Phi-3.5-mini variants), to act as automatic evaluators of semantic equivalence in French medical open-ended QA. Our analysis reveals that LLM-based judgments are sensitive to the source of answer generation: judgement correlation varies substantially across different generator models. Among the judges, MedGemma-27B and Qwen-80B achieve the highest agreement with expert annotations in terms of F1 score and Pearson correlation. We further explore lightweight adaptation strategies on Phi-3.5-mini using supervised fine-tuning (SFT) and Group Relative Policy Optimization (GRPO). Even with 184 training instances, these adaptations significantly improve Phi-3.5’s results and reduce variability across answer generators, achieving performance comparable to larger domain-adapted models. Our results highlight the importance of generator-aware evaluation, the limitations of general-purpose LLMs in domain-specific settings, and the effectiveness of lightweight adaptation for compact models in low-resource scenarios.