Hospital administrators in Maryland and elsewhere may be forced to spend more money - by hiring more physicians' assistants and nurses - to cope with new restrictions on hours for medical residents.

The roughly 80-hour-per-week work limit announced this week by an accreditation group has won some praise from residents, who have long complained that they're forced to work until they're so exhausted that their patients suffer.

"I'm glad they've taken a small step in the right direction," said Dr. Jhemon Lee, a California radiologist who graduated from the University of Maryland School of Medicine in 1994. "By the end of my residency, almost all of the residents had at least one car accident - that's really a dangerous amount of sleep deprivation."

But other young doctors say the rules set by the Chicago-based Accreditation Council for Graduate Medical Education are unlikely to be enforced by hospitals and contain so many loopholes that they will likely prove useless.

Besides the 80-hour limit, which would take effect next July, the council also said that residents must work fewer than 24 hours at a stretch, with at least 10 hours of rest between shifts.

Reducing hours for residents - new doctors who spend three or more years training at hospitals after earning their medical degrees - is likely to prove complex, hospital administrators say. Many at area institutions are studying the new rules.

Hospitals have long used residents as a form of cheap labor, working them 100 or more hours per week and paying them a fraction of what other doctors would earn.

Traditionalists have argued that forcing residents to work long hours helps them learn to remain focused under taxing circumstances. It also allows more continuity of care, they say, so patients aren't handed off to one doctor after another.

"If you are the person who met the patient and his or her family when they came in, and you are with him for a long time, you can better picture the entire situation and that information can make you a better doctor," said Dr. Sarah Ying, a Hopkins-educated neurologist who favors the new limits but also sees a downside to them.

Dr. David Rorison, senior vice president of medical affairs at the University of Maryland Medical System, which has about 500 residents, said his institution is examining the rules.

He said that although many residents in internal medicine, emergency medicine and other areas work less than 80 hours a week, surgery residents and obstetrics residents sometimes work 100 hours a week and could be affected.

Rorison speculated that Maryland might have to hire more nurses and physicians' assistants to monitor patients and perform minor tasks - a potential challenge because the hospital is strapped for money and short on nurses.

Maryland lends some of its residents to community hospitals, such as Mercy Medical Center and Union Memorial Hospital, for a fee. These programs may have to be trimmed or the fees raised, Rorison said.

"We are trying to achieve a balance between what's affordable and what's good for the education of our residents and the care of our patients," Rorison said.

The Johns Hopkins Medical Institutions, which have more than 600 residents, anticipated the problems and have been working to reduce residents' hours for several years, said spokesman Gary Stephenson. Hopkins has added several nurses and physicians in the past year to handle minor tasks - such as patient transportation and paperwork - so residents can be freed up, he said.

"Currently, most residents' training programs at Hopkins are already in compliance with the 80-hour work week ... and we are moving toward total compliance," Stephenson said. "The impact of the new rules on Hopkins will be minimal."

Amanda Guma, an organizer for the New York-based Committee of Interns and Residents, said the announcement this week was a positive sign, but she said the rules are too weak and are riddled with loopholes.

Hospitals can stretch the 80-hour limit by 10 percent for "educational purposes," so the limit is really 88 hours a week, Guma said.

And even that figure is meant to be an average over four weeks - meaning a resident could still be forced to work more than 120 hours in one week if he or she works significantly less the next week, Guma said.

Also, the limit of 24 hours per shift - plus six hours for emergencies or educational purposes - is still too long, Guma said.

"We know that after a shift of 16 hours, an individual's cognitive abilities are impaired, and after 24 hours your mental abilities are like those of someone who's intoxicated, and that's a serious patient-safety issue," said Guma, whose group is seeking federal legislation that would impose a 24-hour limit.