Other operating systems have drawbacks as well.
It's probably a safer and maybe even more efficient bet to just do the stats and opens and hope that the kernel/OS file system caches will save the day. Or you can go the nginx route and not support .htaccess like facilities (e.g. turn if off in apache).
You can also detect when you have too many watches needed or a network filesystem to fall back to the existing path. It’s a philosophical difference ultimately.
Changes being adding a new file, changes to an existing one and so on.
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While I hadn't thought of it, I haven't noticed issues around it. Using a platform like Drupal, Wordpress, Django, etc most paths don't exist on disk and just fall to the index file or get proxied to another server.
So this might be an issue for static files uploaded or static sites. Talking about Drupal and Wordpress, that would usually be,
sites/default/files/
wp-content